Citizens, their agents and health care rationing: an exploratory study using qualitative methods
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.
Volume (Year): 10 (2001)
Issue (Month): 2 ()
|Contact details of provider:|| Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749|
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- 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.
- 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.
- Ayres, Philip J., 1996. "Rationing health care: Views from general practice," Social Science & Medicine, Elsevier, vol. 42(7), pages 1021-1025, April.
- 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.
- Glenn M. MacDonald, 1984. "New Directions in the Economic Theory of Agency," Canadian Journal of Economics, Canadian Economics Association, vol. 17(3), pages 415-40, August.
- Evans, Robert G., 1987. "Public health insurance: the collective purchase of individual care," Health Policy, Elsevier, vol. 7(2), pages 115-134, April.
- 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.
- 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.
- 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.
- 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.
- Joanna Coast, 1999. "The appropriate uses of qualitative methods in health economics," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 345-353.
- 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.
- 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.
- 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.
- 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.
- Loomes, Graham & Sugden, Robert, 1982. "Regret Theory: An Alternative Theory of Rational Choice under Uncertainty," Economic Journal, Royal Economic Society, vol. 92(368), pages 805-24, December.
- 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.
- 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.
- 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.
- 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.
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)
If references are entirely missing, you can add them using this form.