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The Relevance of Personal Characteristics in Health Care Rationing: What the Australian Public Thinks and Why

Authors


  • Professor Jeff Richardson is the Founding Director of the Centre for Health Economics at Monash University, Clayton, Victoria 3800, Australia; e-mail: jeff.richardson@buseco.monash.edu.au. His research interests include health outcomes and health systems research, conceptual and ethical issues in the use of cost-utility analysis, and international health care systems. Along with Dr. McKie he co-authored the book, The Allocation of Health Care Resources, published by Ashgate.

  • Dr. John McKie is a Senior Research Fellow in the Centre for Health Economics at Monash University, Clayton, Victoria 3800, Australia; e-mail: john.mckie@buseco.monash.edu.au. His research interests include the measurement of social values and the allocation of health care resources.

  • Mr. Angelo Iezzi is a Research Fellow in the Centre for Health Economics at Monash University, Clayton, Victoria 3800, Australia; e-mail: angelo.iezzi@buseco.monash.edu.au. His research interests include the design and development of quality-of-life instruments using the Time Trade-Off (TTO), Person Trade-Off (PTO), and Relative Social Willingness To Pay (RS-WTP) techniques.

  • Dr. Munir Khan is a Research Fellow in the Centre for Health Economics at Monash University, Clayton, Victoria 3800, Australia; e-mail: munir.khan@monash.edu. His interests include quality-of-life research, regional disparities of economic development, and income inequalities. The authors would like to thank Anita Niranjin, a Ph.D. student from the University of Melbourne, for her valuable research assistance.

Abstract

This article examines the preferences of the general public in Australia regarding health care resource allocation. While previous studies have revealed that the public is willing to give priority to particular groups of patients based on their personal characteristics, the present article goes beyond previous efforts in attempting to explain these results. In the present study, there was strong support among respondents for giving “equal priority” to people regardless of their personal characteristics. However, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners, and good community contributors. Further, they would give a lower priority to those perceived as “self-harmers”—smokers, individuals with unhealthy diets, and those who rarely exercise. Variation in the answers according to broad economic and social beliefs across seven different categories (“factors”) influenced the pattern of the public's attitudes towards rationing. The Principal Components Analysis (PCA) indicated that most of the items in our survey are associated with seven factors that explain or capture much of the variation. These relate to a patient's avoidance of self-harm behaviors (Safe Living), their Life Style (diet, exercise, etc.), their contribution to the community through caring for others (Caring), their talents (Gifted), their sexual behavior (Sexuality), their age and marital status (Family), and whether they are an Australian citizen or employed (Citizen). The strength of social preferences—e.g., how strongly respondents would “discriminate” against a recreational drug user or preference a person with a healthy diet—is related to the particular class of preferences.

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