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Priority Setting and Patient Adaptation to Disability and Illness: Outcomes of a Qualitative Study

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Abstract

The study examined the question of who should make decisions for a National Health Scheme about the allocation of health resources when the health states of beneficiaries could change because of adaptation. Eight semi-structured small group discussions were conducted. Following focus group theory, interviews commenced with general questions followed by transition questions and ended with a ‘focus’ or ‘key’ question. Participants were presented with several scenarios in which patients adapted to their health states. They were then asked their views about the appropriate role of the public, patients and health professionals in making social judgements of quality of life. After discussion and debate, all groups were asked the key question: ‘In light of adaptation, who should evaluate quality of life for the purpose of setting priorities in the allocation of health care?’ In all groups participants presented strong arguments for and against decision making by patients, the public and health professionals. However, most groups thought a representative body which included a range of perspectives should make the relevant judgements. This is at odds with the recommendations in most national pharmaceutical guidelines. The main conclusion of the paper is that health economists and other researchers should explore the possibility of adopting a deliberative, consensus-based approach to evaluating health-related quality of life when such judgements are to be used to inform priority setting in a public system.

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Notes

  1. These codes will be used later in the paper to refer to sources of quotes—i.e. H = Health Professional, P = Member of the Public, C = Consumer. 1, 2, 3 denote subsets within each of these categories.

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Acknowledgments

This work was supported by a grant from the National Health and Medical Research Council (Grant No. 284258). The authors gratefully acknowledge the support of the council.

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The authors declare that they have no competing interests.

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Correspondence to John McKie.

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McKie, J., Hurworth, R., Shrimpton, B. et al. Priority Setting and Patient Adaptation to Disability and Illness: Outcomes of a Qualitative Study. Health Care Anal 22, 255–271 (2014). https://doi.org/10.1007/s10728-013-0240-9

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