Citizen participation in patient prioritization policy decisions: an empirical and experimental study on patients' characteristics.
Citizen participation in patient prioritization policy decisions: an empirical and experimental study on patients' characteristics.
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DOI：
10.1371/journal.pone.0036824
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Wirsik N
中科院分区：
文献类型：
--
作者：
Diederich A;Swait J;Wirsik N
世界各地的卫生系统都在努力控制成本，以维持系统的可行性。随着经济状况恶化、人口老龄化和税收减少，预计进行结构改革的压力将继续增加。常见的费用控制机制，例如减少病人就医和优先治疗，可能会受到公民的负面评价。因此，将他们纳入导致政策变化的决策过程似乎是明智的。在一个多层次的迭代混合方法设计的背景下，定量调查代表德国人口（N = 2031）进行了调查，以探讨接受医学的优先设置，并探讨直接公众参与的实用性。 在这里，我们重点关注患者的特征（医疗方面，生活方式和社会经济地位）的偏好，作为优先考虑医疗服务的可能标准。一个封闭的回答选项的问卷调查，以深入了解患者群体的广泛的优先标准的态度。此外，一个离散的选择实验被用来作为一个严格的方法来调查公民对特定的标准水平在其他标准的背景下的偏好。问卷调查和离散选择实验均采用同一样本进行。公民自身的健康和社会状况被列为解释变量。资料评估采用对应分析、列联分析、逻辑回归及多项分解逻辑模型。结果表明，一些医疗标准是高度接受的优先考虑病人，而社会经济标准被拒绝。
Health systems worldwide are grappling with the need to control costs to maintain system viability. With the combination of worsening economic conditions, an aging population and reductions in tax revenues, the pressures to make structural changes are expected to continue growing. Common cost control mechanisms, e.g. curtailment of patient access and treatment prioritization, are likely to be adversely viewed by citizens. It seems therefore wise to include them in the decision making processes that lead up to policy changes. In the context of a multilevel iterative mixed-method design a quantitative survey representative of the German population (N = 2031) was conducted to probe the acceptance of priority setting in medicine and to explore the practicability of direct public involvement. Here we focus on preferences for patients' characteristics (medical aspects, lifestyle and socio-economic status) as possible criteria for prioritizing medical services. A questionnaire with closed response options was fielded to gain insight into attitudes toward broad prioritization criteria of patient groups. Furthermore, a discrete choice experiment was used as a rigorous approach to investigate citizens' preferences toward specific criteria level in context of other criteria. Both the questionnaire and the discrete choice experiment were performed with the same sample. The citizens' own health and social situation are included as explanatory variables. Data were evaluated using corresponding analysis, contingency analysis, logistic regression and a multinomial exploded logit model. The results show that some medical criteria are highly accepted for prioritizing patients whereas socio-economic criteria are rejected.
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