Public views on health care rationing: a group discussion study

This small-scale study develops a new methodology for investigating which e thical principles of health care rationing the public support after discuss ion and deliberation. In ten groups of about six people, members of the pub lic are asked to discuss a hypothetical rationing choice, concerning four i dentified patients who are described in general terms but without detailed information. It is explained to respondents that the purpose of the exercis e is to find out what general ethical principles they support. Discussions are chaired by an academic specialising in health policy, whose role is to encourage debate but not actively to participate. On the basis of an innova tive qualitative data analysis, which translates what people say into ethic al principles identified in the theoretical literature, the public appear t o support three main rationing principles: (1) a broad 'rule of rescue' tha t gives priority to those in immediate need, (2) health maximisation and (3 ) equalisation of lifetime health. To our knowledge, this pluralistic viewp oint on rationing has never been developed into a coherent theoretical posi tion, nor into a quantifiable model that health care managers can use for g uidance. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.