[Medical judgment and legal security. Physicians as gatekeepers in the distribution of public goods].
We wanted to explore general practitioners' discretionary judgments about the eligibility of patients applying for disability pension, and to examine if variations in such judgments are correlated with the physicians' personal values and moral standards. Data were collected by a postal questionnaire, which included two vignettes focusing on whether the "applicant" fulfils the eligibility criteria for disability benefit. Variations in judgments were then analysed in correlation to the GP's view on normative questions concerning the physicians' role as gatekeepers, the disability pension as a source of income, and an indicator of the GP's scepticism to the disability pension. 360 general practitioners from eight different counties in Norway participated. The response rate was 62 per cent. The assessment of the vignettes revealed great variation. Four out of ten general practitioners concluded that the first vignette fulfilled the medical eligibility criteria, while three out of ten came to the opposite conclusion. For the second vignette the results were reversed. For both vignettes, three out of ten were not able to answer "yes" or "no" because of uncertainty. Further, the variation in judgments was correlated with an indicator of the GPs' personal values and moral standards. The stronger expressed disability pension scepticism, the more restrictive interpretation of the medical eligibility criteria. A decision on entitlement to disability pension pertains to the distribution of public goods. The general practitioners' discretionary judgments are crucial in this decision-making. When doctors let their political and moral standards influence their judgment, they act arbitrarily and in conflict with ideals of equal treatment and legal security.
Senter for profesjonsstudier Høgskolen i Oslo.
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D000328:Adult; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018868:Insurance, Disability; D007883:Legislation, Medical; D008297:Male; D008875:Middle Aged; D009664:Norway; D010415:Pensions; D010819:Physician's Role; D010821:Physicians, Family / Q000523:psychology; D012943:Social Security; D012946:Social Welfare; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation
Medisinsk skjønn og rettstryggleik. Legar som portvakter i fordelinga av offentlege goder.