Bedside Treatment Decisions: An Evaluation of the Factors Physicians Take into Consideration When Making Complex Rationing Decisions

Background: The budget limitations that are imposed on health care providers often force caregivers to become rationers, and physicians are required to select which patients receive treatments and which go without on a daily basis. This involves making highly complex decisions, and physicians are required to evaluate both relevant and irrelevant parameters to ensure the final decision is sound. Objective: This research examined which of seven parameters physicians used to make rational decisions as to which of a group of five patients in need received treatment. Method: An experiment was conducted in which the decision relevance of objective parameters and additional information about the needy, such as gender or smoking habits, were investigated. Results and conclusion: The findings indicated that physicians focus on central disease-related criteria very well and, thus, arrive at a comprehensive rationing decision, even in complex situations.

Bedside healthcare rationing dilemmas: a survey from Croatia

Purpose The purpose of this paper is to explore Croatian views about issues regarding bedside rationing decisions. Design/methodology/approach An online questionnaire was used to collect data from a sample of 243 Croatian citizens. In a context of hypothetical scenarios involving priority setting decisions taking by physicians, the present study elicits Croatian respondents’ views concerning: the ethical principles that should guide patients prioritization; the parties that should make prioritization decisions; and the likelihood of healthcare rationing becoming a reality. Descriptive analysis, factor analysis and parametric and non-parametric tests were performed. Findings Findings suggest that Croatian respondents: support multiple substantive rationing criteria, with an incident in favoring the worst-off, reducing inequalities in health, translated in the fair-innings argument and efficiency achievement; appoint health professionals as rationing decision makers; and do not seem to believe in the possibility of patient selection becoming a reality. Practical implications Favoring the worst-off, equalizing life time health and the pursuit of efficiency seem to be the criteria most preferred by Croatian respondents to guide rationing policy at the micro level. Originality/value This study is the first attempt to elicit Croatian opinions concerning several rationing criteria inherent in healthcare micro allocation decisions. Healthcare rationing is a serious challenge to Croatian policy makers and so it would be useful for the public’s perceptions and beliefs to be considered.