Opinions of Swedish citizens health‐care politicians administrators and doctors on rationing and health‐care financing

摘要

>Objective  To compare the views of citizens and health‐care decision‐makers on health‐care financing, the limits of public health‐care, and resource allocation. >Design  A postal survey based on a randomized sample of adults taken by the national registration and stratified samples of health‐care politicians, administrators, and doctors in five Swedish counties. >Participants  A total number of 1194 citizens (response rate 60%) and 427 decision‐makers (response rate 69%). >Results  The general public have high expectations of public health‐care, expectations that do not fit with the decision‐makers' views on what should be offered. To overcome the discrepancy between demand and resources, physicians prefer increased patient fees and complementary private insurance schemes to a higher degree than do the other respondents. Physicians take a more favourable view of letting politicians on a national level exert a greater influence on resource allocation within public health‐care. A majority of physicians want politicians to assume a greater responsibility for the exclusion of certain therapies or diagnoses. Most politicians, on the other hand, prefer physicians to make more rigorous decisions as to which medical indications should entitle a person to public health‐care. >Conclusions  The gap between public expectations and health‐care resources makes it more important to be clear about who should be accountable for resource‐allocation decisions in public health‐care. Significant differences between physicians' and politicians' opinions on financing and responsibility for prioritization make the question of accountability even more important.