IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v10y2001i2p159-174.html
   My bibliography  Save this article

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

Author

Listed:
  • Joanna Coast

    (Department of Social Medicine, University of Bristol, UK)

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.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:hlthec:v:10:y:2001:i:2:p:159-174
    DOI: 10.1002/hec.576
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1002/hec.576
    File Function: Link to full text; subscription required
    Download Restriction: no

    References listed on IDEAS

    as
    1. Loomes, Graham & Sugden, Robert, 1982. "Regret Theory: An Alternative Theory of Rational Choice under Uncertainty," Economic Journal, Royal Economic Society, vol. 92(368), pages 805-824, December.
    2. Mooney, Gavin, 1998. ""Communitarian claims" as an ethical basis for allocating health care resources," Social Science & Medicine, Elsevier, vol. 47(9), pages 1171-1180, November.
    3. Joanna Coast, 1999. "The appropriate uses of qualitative methods in health economics," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 345-353.
    4. Vick, Sandra & Scott, Anthony, 1998. "Agency in health care. Examining patients' preferences for attributes of the doctor-patient relationship," Journal of Health Economics, Elsevier, vol. 17(5), pages 587-605, October.
    5. Peter A. Ubel & Jeff Richardson & Paul Menzel, 2000. "Societal value, the person trade-off, and the dilemma of whose values to measure for cost-effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 127-136.
    6. Zeelenberg, Marcel & van Dijk, Wilco W. & Manstead, Antony S. R., 1998. "Reconsidering the Relation between Regret and Responsibility," Organizational Behavior and Human Decision Processes, Elsevier, vol. 74(3), pages 254-272, June.
    7. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Maximizing health benefits vs egalitarianism: An Australian survey of health issues," Social Science & Medicine, Elsevier, vol. 41(10), pages 1429-1437, November.
    8. Glenn M. MacDonald, 1984. "New Directions in the Economic Theory of Agency," Canadian Journal of Economics, Canadian Economics Association, vol. 17(3), pages 415-440, August.
    9. Zeelenberg, M. & van Dijk, W.W. & Manstead, J., 1998. "Reconsidering the relation between regret and responsibility," Discussion Paper 1998-36, Tilburg University, Center for Economic Research.
    10. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Who cares about cost? Does economic analysis impose or reflect social values?," Health Policy, Elsevier, vol. 34(2), pages 79-94, November.
    11. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148.
    12. Mooney, Gavin & Ryan, Mandy, 1993. "Agency in health care: Getting beyond first principles," Journal of Health Economics, Elsevier, vol. 12(2), pages 125-135, July.
    13. Ayres, Philip J., 1996. "Rationing health care: Views from general practice," Social Science & Medicine, Elsevier, vol. 42(7), pages 1021-1025, April.
    14. Zeelenberg, M. & van Dijk, W.W. & Manstead, A.S.R., 1998. "Reconsidering the relation between regret and responsibility," Other publications TiSEM fa17bcac-aab0-4f37-8183-5, Tilburg University, School of Economics and Management.
    15. Bowling, Ann & Jacobson, Bobbie & Southgate, Lesley, 1993. "Explorations in consultation of the public and health professionals on priority setting in an inner London health district," Social Science & Medicine, Elsevier, vol. 37(7), pages 851-857, October.
    16. Cookson, Richard & Dolan, Paul, 1999. "Public views on health care rationing: a group discussion study," Health Policy, Elsevier, vol. 49(1-2), pages 63-74, September.
    17. Evans, Robert G., 1987. "Public health insurance: the collective purchase of individual care," Health Policy, Elsevier, vol. 7(2), pages 115-134, April.
    18. Maria Goddard & Russell Mannion & Peter Smith, 2000. "Enhancing performance in health care: a theoretical perspective on agency and the role of information," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 95-107.
    19. Farrar, Shelley & Ryan, Mandy & Ross, Donald & Ludbrook, Anne, 2000. "Using discrete choice modelling in priority setting: an application to clinical service developments," Social Science & Medicine, Elsevier, vol. 50(1), pages 63-75, January.
    20. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Riise, Julie & Hole, Arne Risa & Gyrd-Hansen, Dorte & Skåtun, Diane, 2016. "GPs' implicit prioritization through clinical choices – evidence from three national health services," Journal of Health Economics, Elsevier, vol. 49(C), pages 169-183.
    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. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. Dror, David Mark & Koren, Ruth & Ost, Alexander & Binnendijk, Erika & Vellakkal, Sukumar & Danis, Marion, 2007. "Health insurance benefit packages prioritized by low-income clients in India: Three criteria to estimate effectiveness of choice," Social Science & Medicine, Elsevier, vol. 64(4), pages 884-896, February.
    10. 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.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:10:y:2001:i:2:p:159-174. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley-Blackwell Digital Licensing) or (Christopher F. Baum). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.