A
major advantage of living in the developed world is that there is access to
health care, but an increasing worry surrounds the current debate as how to pay
for it as the technology improves and becomes more expensive. The age
demographic of many populations is bringing this into sharper focus.
Before
we get to decisions on rationing, there are questions on prioritizing or
putting people to the back of the queue, that is posteriorizing them. Diederich
et al decided to ask 1915 German
citizens for their preferences should the costs of health care force changes.
Their results are in the current issue of the Public Library of Science (1).
The
good citizens were given two sets of criteria onwhich to base their
prioritization or not as the case may be. The first set were health-based
issues such as acute illness, life threatening conditions, chronic conditions,
age etc.
The
second set was the patient’s socio-economic status with issues such as high
income, social responsibility, working age, professional responsibility, etc.
In
general, serious illness and children were accepted as priority cases, whilst
things like having a high income or being socially active were certainly not
reasons to be given priority. These are views that most of us would espouse in
public, but there was a lot more granularity when the participants were grouped
in terms of having a healthy lifestyle, their socio-economic status, age or current health
status.
For
example the lower socio-economic group were coupled with those living a healthy
life style in that they were keener on giving priority to seniors, children and
people with children. The old codgers were less happy with priority to children
or to people with children. The young people were more likely to support priority
for people with mental handicaps.
When
you start digging it looks like medical queue jumping won’t be generally
popular, but would be tolerated for the very sick and maybe some kids, but even
then there would be some muttering. Clearly, the size of your bank balance
should not influence the triage. It appears that we need to find better
solutions – could there be solutions via our smartphones and robots?
