Will elderly patients stand aside for younger patients in the queue for cardiac services?
BACKGROUND
Fair management of queues for hospital-based services requires consideration of clinical need, but there is no information on public attitudes towards non-clinical factors such as age or work status as determinants of priority.


METHODS
We asked elderly residents of Padova, Italy, whether, if they were awaiting cardiac surgery or an outpatient cardiology consultant, they would give up their place in line for a younger or self-employed individual. We also elicited responses from a convenience sample of younger health workers asked to imagine themselves as elderly persons facing the same choices.


RESULTS
The eligible response rate was 72% (443/616). About half deemed it right to give up their place in line for cardiac surgery to a 45-year-old (51%, 95% CI 46-56) or self-employed person (47%, 95% CI 42-51) Proportions were significantly higher for an outpatient consultation (68%, 95% CI 63-72). In multivariate analyses, married respondents, those closer to age 65, university graduates, and those who were formerly self-employed were significantly less likely to respond affirmatively. In significant contrast for all four scenarios (p<0.0001), the overwhelming majority of non-elderly respondents refused to give up their places in line.


CONCLUSIONS
The majority of elderly citizens were hypothetically willing to cede priority in accessing cardiac care to younger or self-employed persons, but this willingness was attenuated among the "young" elderly and more privileged respondents. Non-elderly respondents were much less self-sacrificing, suggesting that ageing baby-boomers may be more assertive about their continuing rights to health care.
Mariotto
A
A
Unit for Technology Assessment and Quality Assurance, Medical Directorate, Padova, Italy. farmosp16@pd.nettuno.it
De Leo
D
D
Buono
M D
MD
Favaretti
C
C
Austin
P
P
Naylor
C D
CD
D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D006348:Cardiac Surgical Procedures / Q000639:trends*; D016507:Cardiology Service, Hospital / Q000639:trends*; D005260:Female; D005544:Forecasting; D006292:Health Priorities / Q000639:trends; D006301:Health Services Needs and Demand / Q000639:trends; D006299:Health Services for the Aged / Q000600:supply & distribution*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D040841:Resource Allocation; D014850:Waiting Lists