Physicians' attitudes toward health care rationing

Background. Optimal allocation of health care resources under a limited budget is controversial. Particularly important questions are whether rationing decisions should be based on efficiency considerations alone or in combination with equity considerations, and who should be in charge of such decisions. In this study, the authors sought to understand the position of Swiss physicians toward rationing using a previously developed rationing scenario. Methods. The authors examined the acceptability of various scenarios implementing health care rationing in a mail survey of 1184 physicians practicing in Geneva, Switzerland. Respondents were asked to choose between providing a suboptimal cancer screening test A to the whole population, which would save 1000 lives, or selecting half of the population to receive a better but more expensive test B, which would save 1100 lives. Physicians were randomly assigned to 3 versions of the scenario: Beneficiaries of test B could be chosen by lottery, on a first-come-first-served basis, or by medical associations. Results. Only 26% of physicians chose the more effective selective rationing option; this proportion was lowest when test beneficiaries were selected by lottery (14%), intermediate for the first-come-first-served scenario (26%), and highest when selection was left to medical associations (39%; P < 0.001). Hospital based physicians and general practitioners were less likely to endorse selective rationing than community-based physicians and specialists. Conclusion. Swiss physicians appear to be more concerned about equal allocation of health services than about maximizing health in society, and they prefer physicians to be in charge of rationing decisions.