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Withdrawing versus Withholding Treatments in Medical Reimbursement Decisions: A Study on Public Attitudes

Author

Listed:
  • Liam Strand

    (Swedish National Centre for Priorities in Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Sweden)

  • Lars Sandman

    (Swedish National Centre for Priorities in Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Sweden)

  • Emil Persson

    (Department of Management and Engineering, Linköping University, Sweden)

  • David Andersson

    (Department of Management and Engineering, Linköping University, Sweden)

  • Ann-Charlotte Nedlund

    (Swedish National Centre for Priorities in Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Sweden)

  • Gustav Tinghög

    (Swedish National Centre for Priorities in Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Sweden
    Department of Management and Engineering, Linköping University, Sweden)

Abstract

Background The use of policies in medical treatment reimbursement decisions, in which only future patients are affected, prompts a moral dilemma: is there an ethical difference between withdrawing and withholding treatment? Design Through a preregistered behavioral experiment involving 1,067 participants, we tested variations in public attitudes concerning withdrawing and withholding treatments at both the bedside and policy levels. Results In line with our first hypothesis, participants were more supportive of rationing decisions presented as withholding treatments compared with withdrawing treatments. Contrary to our second prestated hypothesis, participants were more supportive of decisions to withdraw treatment made at the bedside level compared with similar decisions made at the policy level. Implications Our findings provide behavioral insights that help explain the common use of policies affecting only future patients in medical reimbursement decisions, despite normative concerns of such policies. In addition, our results may have implications for communication strategies when making decisions regarding treatment reimbursement. Highlights We explore public’ attitudes toward withdrawing and withholding treatments and how the decision level (bedside or policy level) matters. People were more supportive of withholding medical treatment than of withdrawing equivalent treatment. People were more supportive of treatment withdrawal made at the bedside than at the policy level. Our findings help clarify why common-use policies, which impact only future patients in medical reimbursement decision, are implemented despite the normative concerns associted with thesepolicies.

Suggested Citation

  • Liam Strand & Lars Sandman & Emil Persson & David Andersson & Ann-Charlotte Nedlund & Gustav Tinghög, 2024. "Withdrawing versus Withholding Treatments in Medical Reimbursement Decisions: A Study on Public Attitudes," Medical Decision Making, , vol. 44(6), pages 641-648, August.
  • Handle: RePEc:sae:medema:v:44:y:2024:i:6:p:641-648
    DOI: 10.1177/0272989X241258195
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    References listed on IDEAS

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    1. Emil Persson & David Andersson & Lovisa Back & Thomas Davidson & Emma Johannisson & Gustav Tinghög, 2018. "Discrepancy between Health Care Rationing at the Bedside and Policy Level," Medical Decision Making, , vol. 38(7), pages 881-887, October.
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