US neurologists - Attitudes on rationing

Objective: To assess neurologists' attitudes on rationing health care and t o determine whether neurologists would set healthcare priorities in ways th at are consistent with cost-effectiveness research. Background: Cost-effect iveness research can suggest ways to maximize health benefits within fixed budgets but is currently being underused in resource allocation decisions. Methods: The authors surveyed a random sample of neurologists practicing in the United States (response rate, 44.4%) with three hypothetical scenarios . Two scenarios were designed to address general attitudes on allocating fi nite resources with emphasis on formulary decisions for costly drugs. The t hird scenario was designed to assess whether neurologists would optimize th e allocation of a fixed budget as recommended by cost-effectiveness analysi s. Results: Three-quarters of respondents thought that neurologists make da ily decisions that effectively ration healthcare resources, and 60% felt a professional responsibility to consider the financial impact of individuali zed treatment decisions on other patients. Only 25% of respondents thought that there should be no restrictions placed on any of the five newer antiep ileptic agents. Tn a 1995 survey, 75% of similarly sampled neurologists agr eed that no restrictions should be placed on the availability of FDA-approv ed medications. Nearly half (46%) of respondents favored a less effective t est and would be willing to let patients die to ensure the offering of a mo re equitable alternative. Conclusions: Most neurologists recognize the need to ration health care, and although they think cost-effectiveness research is one method to achieve efficient distribution of resources, many think t hat considerable attention should also be given to equity.