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Attitudes towards priority-setting and rationing in healthcare — an exploratory survey of Swedish medical students

Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, faisal.omar{at}liu.se

Gustav Tinghög

Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

Petter Tinghög

Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

Per Carlsson

Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

Background: Healthcare priority-setting is inextricably linked to the challenge of providing publicly funded healthcare within a limited budget, which may result in difficult and potentially controversial rationing decisions. Despite priority-setting's increasing prominence in policy and academic discussion, it is still unclear what the level of understanding and acceptance of priority-setting is at different levels of health care. Aims: The aim of this study is threefold. First we wish to explore the level of familiarity with different aspects of priority-setting among graduating medical students. Secondly, to gauge their acceptance of both established and proposed Swedish priority-setting principles. Finally to elucidate their attitudes towards healthcare rationing and the role of different actors in decision making, with a particular interest in comparing the attitudes of medical students with data from the literature examining the attitudes among primary care patients in Sweden. Methods: A cross-sectional survey containing 14 multiple choice items about priority-setting in healthcare was distributed to the graduating medical class at Linkoöping University. The response rate was 92% (43/47). Results: Less than half of respondents have encountered the notion of open priority-setting, and the majority believed it to be somewhat or very unclear. There is a high degree of awareness and agreement with the established ethical principles for priority-setting in Swedish health care; however respondents are inconsistent in their application of the cost-effectiveness principle. A larger proportion of respondents were more favourable to physicians and other health personnel being responsible for rationing decisions as opposed to politicians. Conclusions: Future discussion about priority-setting in medical education should be contextualized within an explicit and open process. There is a need to adequately clarify the role of the cost-effectiveness principle in priority-setting. Medical students seem to acknowledge the need for rationing in healthcare to a greater extent when compared with previous results from Swedish primary care patients.

Key Words: Ethical principles • healthcare • medical education • priority-setting • rationing • Sweden

This version was published on March 1, 2009

Scandinavian Journal of Public Health, Vol. 37, No. 2, 122-130 (2009)
DOI: 10.1177/1403494808100276


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