opinion of physicians clearly counts in prioritizing health care, but there is
little information on the rationales underlying treatment decisions and whether
these rationales are accepted by patients.
Objective: To compare physicians and patients regarding their understanding
and use of therapeutic benefit and treatment costs as criteria for prioritizing
health care. Methods: Seven physicians and twelve patients were purposefully
selected to yield a heterogeneous sample. Participants were interviewed
face-to-face, following a semi-structured topic guide comprising three
scenarios that focused on interventions with low or unproven therapeutic
benefit and high costs, respectively. For data analysis we used qualitative
content analysis. Results: We found that patients and physicians differed in their understanding of therapeutic
benefit, their expectations of what medicine can do and their use of costs as
criteria for prioritizing health care. Physicians were less likely to assess a
certain intervention as effec tive, and they less often accepted upper funding
limits in health care. Unlike the physicians, patients raised non-medical aspects
in decision making such as the patient’s consent and social inequalities.
Conclusions: The revealed differences point toward the necessity to
strengthen the doctor-patient communication, to improve information for
patients about the possibilities and limits of health care and to gain a deeper understanding of their attitudes, wishes and
concerns to reach an agreement by physicians and patients on the
treatment to be implemented.