Attitudes towards priority setting in the norwegian health care system: a general population survey

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Abstract

Background

In an ideal world, everyone would receive medical resources in accordance with their needs. In reality, resources are often scarce and have an alternative use. Thus, we are forced to prioritize. Although Norway is one of the leading countries in normative priority setting work, few descriptive studies have been conducted in the country. To increase legitimacy in priority setting, knowledge about laypeople’s attitudes is central. The aim of the study is therefore to assess the general population’s attitudes towards a broad spectrum of issues pertinent to priority setting in the Norwegian publicly financed health care system.

Methods

We developed an electronic questionnaire that was distributed to a representative sample of 2 540 Norwegians regarding their attitudes towards priority setting in Norway. A total of 1 035 responded (response rate 40.7%). Data were analyzed with descriptive statistics and binary logistic regression.

Results

A majority (73.0%) of respondents preferred increased funding of publicly financed health services at the expense of other sectors in society. Moreover, a larger share of the respondents suggested either increased taxes (37.0%) or drawing from the Government Pension Fund Global (31.0%) as sources of funding. However, the respondents were divided on whether it was acceptable to say “no” to new cancer drugs when the effect is low and the price is high: 38.6% somewhat or fully disagreed that this was acceptable, while 46.5% somewhat or fully agreed. Lastly, 84.0% of the respondents did not find it acceptable that the Norwegian municipalities have different standards for providing care services.

Conclusion

Although the survey suggests support for priority setting among Norwegian laypeople, it has also revealed that a significant minority are reluctant to accept it.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07806-9.

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Most cited references 16

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A new proposal for priority setting in Norway: Open and fair.

Trygve Ottersen, Reidun Førde, Meetali Kakad … (2016)

Health systems worldwide struggle to meet increasing demands for health care, and Norway is no exception. This paper discusses the new, comprehensive framework for priority setting recently laid out by the third Norwegian Committee on Priority Setting in the Health Sector. The framework posits that priority setting should pursue the goal of "the greatest number of healthy life years for all, fairly distributed" and centres on three criteria: 1) The health-benefit criterion: The priority of an intervention increases with the expected health benefit (and other relevant welfare benefits) from the intervention; 2) The resource criterion: The priority of an intervention increases, the less resources it requires; and 3) The health-loss criterion: The priority of an intervention increases with the expected lifetime health loss of the beneficiary in the absence of such an intervention. Cost-effectiveness plays a central role in this framework, but only alongside the health-loss criterion which incorporates a special concern for the worse off and promotes fairness. In line with this, cost-effectiveness thresholds are differentiated according to health loss. Concrete implementation tools and open processes with user participation complement the three criteria. Informed by the proposal, the Ministry of Health and Care Services is preparing a report to the Parliament, with the aim of reaching political consensus on a new priority-setting framework for Norway.

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Prevalence and determinants of physician bedside rationing: data from Europe.

Anne-Marie Slowther, Renzo Pegoraro, Bradley S. Hurst … (2006)

Bedside rationing by physicians is controversial. The debate, however, is clouded by lack of information regarding the extent and character of bedside rationing. We developed a survey instrument to examine the frequency, criteria, and strategies used for bedside rationing. Content validity was assessed through expert assessment and scales were tested for internal consistency. The questionnaire was translated and administered to General Internists in Norway, Switzerland, Italy, and the United Kingdom. Logistic regression was used to identify the variables associated with reported rationing. Survey respondents (N=656, response rate 43%) ranged in age from 28 to 82, and averaged 25 years in practice. Most respondents (82.3%) showed some degree of agreement with rationing, and 56.3% reported that they did ration interventions. The most frequently mentioned criteria for rationing were a small expected benefit (82.3%), low chances of success (79.8%), an intervention intended to prolong life when quality of life is low (70.6%), and a patient over 85 years of age (70%). The frequency of rationing by clinicians was positively correlated with perceived scarcity of resources (odds ratio [OR]=1.11, 95% confidence interval [CI] 1.06 to 1.16), perceived pressure to ration (OR=2.14, 95% CI 1.52 to 3.01), and agreement with rationing (OR=1.13, 95% CI 1.05 to 1.23). Bedside rationing is prevalent in all surveyed European countries and varies with physician attitudes and resource availability. The prevalence of physician bedside rationing, which presents physicians with difficult moral dilemmas, highlights the importance of discussions regarding how to ration care in the most ethically justifiable manner.

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Health care priority setting in Norway a multicriteria decision analysis

Thierry Defechereux, Francesco Paolucci, Andrew Mirelman … (2012)

Background Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. Methods In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. Results The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Conclusions Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.

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Author and article information

Contributors

Carl Tollef Solberg:

ORCID: http://orcid.org/0000-0003-3321-3793

c.t.solberg@medisin.uio.no

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 5 April 2022

Publication date PMC-release: 5 April 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 444

Affiliations

[1 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Centre for Medical Ethics (CME), Institute of Health and Society, Faculty of Medicine, , University of Oslo, ; Postbox 1130, Blindern 0318, Oslo, Norway

[2 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, Faculty of Medicine, , University of Bergen, ; Bergen, Norway

[3 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Centre for Cancer Biomarkers (CCBIO), Department of Global Public Health and Primary Care, Faculty of Medicine, , University of Bergen, ; Bergen, Norway

[4 ]GRID grid.446080.e, ISNI 0000 0000 8775 4235, MF Norwegian School of Theology, Religion and Society, ; Oslo, Norway

Author information

Carl Tollef Solberg http://orcid.org/0000-0003-3321-3793

Eirik Joakim Tranvåg http://orcid.org/0000-0001-7196-7858

Morten Magelssen http://orcid.org/0000-0002-5994-8029

Article

Publisher ID: 7806

DOI: 10.1186/s12913-022-07806-9

PMC ID: 8980508

PubMed ID: 35382816

SO-VID: 2c26657a-09e7-49b9-b61d-d2556cea0541

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 November 2021

Date accepted : 15 March 2022

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ScienceOpen disciplines: Health & Social care

Keywords: attitude survey,empirical ethics,general population,legitimacy,norway,priority setting

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ScienceOpen disciplines: Health & Social care

Keywords: attitude survey, empirical ethics, general population, legitimacy, norway, priority setting

Attitudes towards priority setting in the norwegian health care system: a general population survey

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Most cited references 16

A new proposal for priority setting in Norway: Open and fair.

Prevalence and determinants of physician bedside rationing: data from Europe.

Health care priority setting in Norway a multicriteria decision analysis

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