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Citizens, their agents and health care rationing: an exploratory study using qualitative methods

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  • Joanna Coast

Abstract

This paper considers the application of the theoretical notion of a principal–agent relationship to societal health care decision making. Current literature sheds little light upon whether a citizen–agent relationship exists in health care, with ambiguity about whether citizens want agents to make rationing decisions on their behalf, and if so, who these societal agents might be. A qualitative approach, using semi‐structured interviews as the main instrument of data collection and analysis by constant comparison, was used to explore these issues with groups of both citizens and their potential agents. The findings of the research suggest that citizens vary considerably in the extent to which they want to be directly involved in making rationing decisions. Important influences on this issue appear to be knowledge and experience, objectivity and the potential distress that denying care may cause. Agents, in contrast, view citizens as needing agents to make decisions for them and suggest that it is primarily the health authority's role to act in this capacity. It is, however, apparent that the citizen–agent relationship in health care is both imperfect and complex, with final decisions resulting from the interaction between the utility functions of the various actors in the health care system. In practice a system of equivocation can be envisaged in which different groups collude as they attempt to avoid the disutility associated with denying care, with the consequence that the impact of decisions taken on an explicitly societal or citizen basis may be relatively small. Copyright © 2001 John Wiley & Sons, Ltd.

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  • Joanna Coast, 2001. "Citizens, their agents and health care rationing: an exploratory study using qualitative methods," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 159-174, March.
  • Handle: RePEc:wly:hlthec:v:10:y:2001:i:2:p:159-174
    DOI: 10.1002/hec.576
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    Cited by:

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    2. Eddama, Oya & Coast, Joanna, 2008. "A systematic review of the use of economic evaluation in local decision-making," Health Policy, Elsevier, vol. 86(2-3), pages 129-141, May.
    3. David Mark Dror, 2018. "Health Insurance Benefit Packages Prioritized by Low-Income Clients in India: Three Criteria to Estimate Effectiveness of Choice," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 13, pages 253-270, World Scientific Publishing Co. Pte. Ltd..
    4. Kim Olsen & Dorte Gyrd-Hansen & Andreas Boegh & Sofie Hansen, 2009. "GPs as citizens’ agents: prescription behavior and altruism," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(4), pages 399-407, October.
    5. Patten, San & Mitton, Craig & Donaldson, Cam, 2006. "Using participatory action research to build a priority setting process in a Canadian Regional Health Authority," Social Science & Medicine, Elsevier, vol. 63(5), pages 1121-1134, September.
    6. Williams, Iestyn & Bryan, Stirling, 2007. "Understanding the limited impact of economic evaluation in health care resource allocation: A conceptual framework," Health Policy, Elsevier, vol. 80(1), pages 135-143, January.
    7. 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.
    8. Owen-Smith, Amanda & Donovan, Jenny & Coast, Joanna, 2015. "How clinical rationing works in practice: A case study of morbid obesity surgery," Social Science & Medicine, Elsevier, vol. 147(C), pages 288-295.
    9. De Allegri, Manuela & Sanon, Mamadou & Bridges, John & Sauerborn, Rainer, 2006. "Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa," Health Policy, Elsevier, vol. 76(1), pages 58-71, March.
    10. Anabela Botelho & Micaela M. Pinho & Paula Veiga, 2011. "Who and how should participate in health care priority setting? Evidence from a Portuguese survey," NIMA Working Papers 43, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
    11. Rachel Baker & John Wildman & Helen Mason & Cam Donaldson, 2014. "Q‐Ing For Health—A New Approach To Eliciting The Public'S Views On Health Care Resource Allocation," Health Economics, John Wiley & Sons, Ltd., vol. 23(3), pages 283-297, March.
    12. Eddama, Oya & Coast, Joanna, 2009. "Use of economic evaluation in local health care decision-making in England: A qualitative investigation," Health Policy, Elsevier, vol. 89(3), pages 261-270, March.
    13. Mohd Zuhair & Fuli Zhou & Saurabh Pratap & Ram Babu Roy, 2022. "Eliciting key attributes of health insurance in rural India: a qualitative analysis," SN Business & Economics, Springer, vol. 2(3), pages 1-28, March.

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