Physicians' views on resource availability and equity in four European health care systems

Abstract

Background: In response to limited resources, health care systems have adopted diverse cost-containment strategies and give priority to differing types of interventions. The perception of physicians, who witness the effects of these strategies, may provide useful insights regarding the impact of system-wide priority setting on access to care.

Methods: We conducted a cross-sectional survey to ascertain generalist physicians' perspectives on resources allocation and its consequences in Norway, Switzerland, Italy and the UK.

Results: Survey respondents (N = 656, response rate 43%) ranged in age from 28-82, and averaged 25 years in practice. Most respondents (87.7%) perceived some resources as scarce, with the most restrictive being: access to nursing home, mental health services, referral to a specialist, and rehabilitation for stroke. Respondents attributed adverse outcomes to scarcity, and some respondents had encountered severe adverse events such as death or permanent disability. Despite universal coverage, 45.6% of respondents reported instances of underinsurance. Most respondents (78.7%) also reported some patient groups as more likely than others to be denied beneficial care on the basis of cost. Almost all respondents (97.3%) found at least one cost-containment policy acceptable. The types of policies preferred suggest that respondents are willing to participate in cost-containment, and do not want to be guided by administrative rules (11.2%) or restrictions on hospital beds (10.7%).

Conclusion: Physician reports can provide an indication of how organizational factors may affect availability and equity of health care services. Physicians are willing to participate in cost-containment decisions, rather than be guided by administrative rules. Tools should be developed to enable physicians, who are in a unique position to observe unequal access or discrimination in their health care environment, to address these issues in a more targeted way.

Figure 1

Limited resources. During the last six months, how often were you unable to obtain the following services for your patients when you thought they were necessary (this includes unacceptable waiting times)?. Panel A: Percentage of respondents who reported unavailability of resources. ‡Chi-square: p < 0.01; null hypothesis is "no difference". Panel B: mean frequency of reported unavailability of resources. 0 = "never", 1 = "less than once a month", 2 = "once a month", 3 = "weekly", 4 = "daily". *Kruskall-Wallis: p < 0.01; null hypothesis is "no difference".

Figure 2

Reported greater likelihood to be denied treatment based on group identity. Based on your experience, are patients who belong to any of the following groups more likely than others to be denied beneficial care on the basis of cost in your health care environment?. *Pearson Chi-Square: p < 0.01; null hypothesis is "no difference".

Figure 3

Percentage of respondents who agreed with different cost-containment policies. Based on your experience, how acceptable do you consider the following methods of resource allocation to be?. *Kruskall-Wallis: p < 0.01; null hypothesis is "no difference".