IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v85y2013icp66-73.html
   My bibliography  Save this article

Changing expectations concerning life-extending treatment: The relevance of opportunity cost

Author

Listed:
  • Gill, Betty
  • Griffin, Barbara
  • Hesketh, Beryl

Abstract

Rising public expectations and health care costs along with demographic ageing raise questions about whether individuals should consider the drain on community resources when deciding whether to have expensive, life-extending medical interventions towards the end of their lifespan. All respondents (n = 208) in this novel, policy-capturing study were prepared to nominate an age along their life trajectory where they would likely decline a life-extending medical intervention indicating a “sense of limits” or “reasonableness” associated with the concept of a natural lifespan. The results showed that individuals altered end-of-life decisions in circumstances of higher opportunity cost and competing need but their propensity to do so was affected by their age, gender, and their expectations of medical progress. Other within-person factors (type of scarcity, treatment side effects, and health at diagnosis) affected the age one would decline a medical intervention in the face of a life threatening illness. Between-person predictors of this age included subjective life expectancy and attitude to health spending. The results suggest possibilities for building on this sense of reasonableness in public discussions of the opportunity cost of current health care resource allocation and by having physicians consider appropriate ways of presenting cost of treatment in end-of life contexts.

Suggested Citation

  • Gill, Betty & Griffin, Barbara & Hesketh, Beryl, 2013. "Changing expectations concerning life-extending treatment: The relevance of opportunity cost," Social Science & Medicine, Elsevier, vol. 85(C), pages 66-73.
  • Handle: RePEc:eee:socmed:v:85:y:2013:i:c:p:66-73
    DOI: 10.1016/j.socscimed.2013.02.040
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953613001330
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2013.02.040?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Mariner, W.K., 1995. "Rationing health care and the need for credible scarcity: Why Americans can't say no," American Journal of Public Health, American Public Health Association, vol. 85(10), pages 1439-1445.
    2. Lenaghan, Jo, 1999. "Involving the public in rationing decisions. The experience of citizens juries," Health Policy, Elsevier, vol. 49(1-2), pages 45-61, September.
    3. Mak, Benise & Woo, Jean & Bowling, Ann & Wong, Florens & Chau, Pui Hing, 2011. "Health care prioritization in ageing societies: Influence of age, education, health literacy and culture," Health Policy, Elsevier, vol. 100(2), pages 219-233.
    4. Mira Johri & Laura J. Damschroder & Brian J. Zikmund‐Fisher & Peter A. Ubel, 2005. "The importance of age in allocating health care resources: does intervention‐type matter?," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 669-678, July.
    5. Ryynänen, Olli-Pekka & Myllykangas, Markku & Kinnunen, Juha & Takala, Jorma, 1999. "Attitudes to health care prioritisation methods and criteria among nurses, doctors, politicians and the general public," Social Science & Medicine, Elsevier, vol. 49(11), pages 1529-1539, December.
    6. Agnes van der Heide & Astrid Vrakking & Hans van Delden & Caspar Looman & Paul van der Maas, 2004. "Medical and Nonmedical Determinants of Decision Making about Potentially Life-Prolonging Interventions," Medical Decision Making, , vol. 24(5), pages 518-524, October.
    7. Busse, Reinhard, 1999. "Priority-setting and rationing in German health care," Health Policy, Elsevier, vol. 50(1-2), pages 71-90, December.
    8. Clive H. Smee, 1997. "Bridging the Gap Between Public Expectations and Public Willingness to Pay," Health Economics, John Wiley & Sons, Ltd., vol. 6(1), pages 1-9, January.
    9. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
    10. Mak, Benise & Woo, Jean & Bowling, Ann & Wong, Florens & Chau, Pui Hing, 2011. "Health care prioritization in ageing societies: Influence of age, education, health literacy and culture," Health Policy, Elsevier, vol. 100(2-3), pages 219-233, May.
    11. Jane Robertson & Emily J Walkom & David A Henry, 2011. "Health Systems and Sustainability: Doctors and Consumers Differ on Threats and Solutions," PLOS ONE, Public Library of Science, vol. 6(4), pages 1-9, April.
    12. Owen-Smith, Amanda & Coast, Joanna & Donovan, Jenny, 2009. ""I can see where they're coming from, but when you're on the end of it ... you just want to get the money and the drug.": Explaining reactions to explicit healthcare rationing," Social Science & Medicine, Elsevier, vol. 68(11), pages 1935-1942, June.
    13. King, Derek & Maynard, Alan, 1999. "Public opinion and rationing in the United Kingdom," Health Policy, Elsevier, vol. 50(1-2), pages 39-53, December.
    14. Gold, Marthe Rachel & Franks, Peter & Siegelberg, Taryn & Sofaer, Shoshanna, 2007. "Does providing cost-effectiveness information change coverage priorities for citizens acting as social decision makers?," Health Policy, Elsevier, vol. 83(1), pages 65-72, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jana Rogge & Bernhard Kittel, 2016. "Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
    2. Dorte Gyrd‐Hansen, 2018. "Is there additional value attached to health gains at the end of life? A revisit," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 71-75, January.
    3. Shah, Koonal K., 2009. "Severity of illness and priority setting in healthcare: A review of the literature," Health Policy, Elsevier, vol. 93(2-3), pages 77-84, December.
    4. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
    5. Broqvist, Mari & Garpenby, Peter, 2015. "It takes a giraffe to see the big picture – Citizens' view on decision makers in health care rationing," Social Science & Medicine, Elsevier, vol. 128(C), pages 301-308.
    6. Jeannette Winkelhage & Adele Diederich, 2012. "The Relevance of Personal Characteristics in Allocating Health Care Resources—Controversial Preferences of Laypersons with Different Educational Backgrounds," IJERPH, MDPI, vol. 9(1), pages 1-21, January.
    7. Jennifer A. Whitty & Julie Ratcliffe & Gang Chen & Paul A. Scuffham, 2014. "Australian Public Preferences for the Funding of New Health Technologies," Medical Decision Making, , vol. 34(5), pages 638-654, July.
    8. Jeff Richardson & John McKie & Angelo Iezzi & Aimee Maxwell, 2017. "Age Weights for Health Services Derived from the Relative Social Willingness-to-Pay Instrument," Medical Decision Making, , vol. 37(3), pages 239-251, April.
    9. Mossialos, Elias & King, Derek, 1999. "Citizens and rationing: analysis of a European survey," Health Policy, Elsevier, vol. 49(1-2), pages 75-135, September.
    10. Olof Johansson‐Stenman & Minhaj Mahmud & Peter Martinsson, 2011. "Saving lives versus life‐years in rural Bangladesh: an ethical preferences approach," Health Economics, John Wiley & Sons, Ltd., vol. 20(6), pages 723-736, June.
    11. Jean Woo, 2017. "Designing Fit for Purpose Health and Social Services for Ageing Populations," IJERPH, MDPI, vol. 14(5), pages 1-8, April.
    12. Palumbo, Rocco & Annarumma, Carmela & Adinolfi, Paola & Musella, Marco & Piscopo, Gabriella, 2016. "The Italian Health Literacy Project: Insights from the assessment of health literacy skills in Italy," Health Policy, Elsevier, vol. 120(9), pages 1087-1094.
    13. Lancsar, Emily & Wildman, John & Donaldson, Cam & Ryan, Mandy & Baker, Rachel, 2011. "Deriving distributional weights for QALYs through discrete choice experiments," Journal of Health Economics, Elsevier, vol. 30(2), pages 466-478, March.
    14. Mortimer, Duncan & Peacock, Stuart, 2012. "Social welfare and the Affordable Care Act: Is it ever optimal to set aside comparative cost?," Social Science & Medicine, Elsevier, vol. 75(7), pages 1156-1162.
    15. Robson, Matthew & O’Donnell, Owen & Van Ourti, Tom, 2024. "Aversion to health inequality — Pure, income-related and income-caused," Journal of Health Economics, Elsevier, vol. 94(C).
    16. Jeff Round & Mike Paulden, 2018. "Incorporating equity in economic evaluations: a multi-attribute equity state approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(4), pages 489-498, May.
    17. Adler, Matthew D. & Ferranna, Maddalena & Hammitt, James K. & Treich, Nicolas, 2021. "Fair innings? The utilitarian and prioritarian value of risk reduction over a whole lifetime," Journal of Health Economics, Elsevier, vol. 75(C).
    18. Vuorenkoski, Lauri & Toiviainen, Hanna & Hemminki, Elina, 2003. "Drug reimbursement in Finland--a case of explicit prioritising in special categories," Health Policy, Elsevier, vol. 66(2), pages 169-177, November.
    19. Jane Robertson & David A Newby & Emily J Walkom, 2016. "Health Care Spending: Changes in the Perceptions of the Australian Public," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-12, June.
    20. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:85:y:2013:i:c:p:66-73. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.