The doctor's changing role in allocating U.S. and British medical services

Preferences for disclosure: the case of bedside rationing

While rationing is present in many health care systems, little empirical research has been undertaken to investigate the public's preferences and information needs towards the rationing of their care. This paper reports the results of an interactive survey administered via an internet survey panel to investigate preferences for the provision of information about explicit rationing decisions. We presented a series of vignettes to respondents, describing hypothetical patients and explicit rationing decisions. In two different survey versions, patients were either characterized as matching or mismatching respondents' age and gender. We observed strong preferences for the disclosure of rationing information to patients. Seventy one percent of responders expressed a general attitude in favor of explicitly informing patients about the rationing of their care. In the presented scenarios, the fraction supporting disclosure to patients ranged from 63% to 89%. The clinical situation described in the vignettes, a positive, general attitude towards the disclosure of rationing decisions, age, and gender of respondents were main predictors for participants' votes. Preferences were relatively unaffected and insensitive to the matching of hypothetical patients and respondents' characteristics. This study suggests that if doctors are to play an active role in health care rationing, patients expect them to honestly discuss the decisions made, the economics behind these and finally, to deal with those patients that do not accept the final decision.