Older people's views of prioritisation and resource allocation in health care

Abstract: The aim of this thesis was to investigate older people's views and experience of prioritisation and resource allocation in health care, which is important because older people are the group that use public health care and service most. The aim was also to investigate differences in the view of prioritisation and resource allocation in relation to age, gender, housing, health-related quality of life, financial situation and degree of dependency between the participants receiving and those not receiving care and service. A further aim was to describe older people's reasoning about prioritisation in health care. The sample was identified in a longitudinal cohort study in southern Sweden called Good Ageing in Skane (GAS), 902 participants not receiving care and service, aged 60?93 years, and 146 participants receiving care and service, aged 66?100 years. Data were collected in personal interviews based on a questionnaire. The total sample was divided into the age groups young-old (60?75 years), old-old (76?84 years) and oldest old (85?100 years). Quantitative descriptive statistics, comparative statistics and multinomial and multiple logistic regression analyses as well as qualitative analyses were used when analysing the data.

Eighty-one percent of the participants not receiving care and service and 85 % of the participants receiving care and service did not want age to be a criterion for prioritisation (Papers I and III) but their reasoning revealed that they experienced that being old meant low priority (Paper IV). In their reasoning the participants saw prioritisation as a necessity but also emphasised that all people are of equal value and that everyone should have the same rights to health care regardless of age (Paper IV). It was clearly stated that the participants wanted physicians to decide who should be prioritised (Papers I and III). The findings also showed that the oldest-old and men prioritised younger people to a higher extent than the other two age groups, while women prioritised older patients to a higher extent (Paper I). The participants not receiving care and service were furthermore reluctant to give priority to treatment for lifestyle-related diseases than participants receiving care and service (Framework). The participants? reasoning in relation to the willingness to pay for treatment revealed that they experienced that buying treatment requires wealth (Paper IV). Most of the participants not receiving care and service (63 %) but only 48 % of participants receiving care and service wanted to pay ?1100 to get cataract surgery at once instead of being on a waiting list for 18 months, but significantly fewer participants receiving care and service actually had access to ?1500 (p<0.001) (Framework). Women were also less willing to pay for treatment than men, which also seemed to be associated with a worse economic situation (Paper II).

The results showed that older people did not emphasise age as a criterion for prioritisation, which is in contrast to earlier studies including younger people. This thesis further showed that age, gender, financial situation and receiving care and service or not, influenced the way the respondents viewed prioritisation and resource allocation, while housing, grade of dependency and HRQoL seemed to have limited influence.