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


CONCLUSIONS
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.
Hurst
Samia A
SA
Institute for Biomedical Ethics, Geneva University Medical School, Switzerland.
Forde
Reidun
R
Reiter-Theil
Stella
S
Slowther
Anne-Marie
AM
Perrier
Arnaud
A
Pegoraro
Renzo
R
Danis
Marion
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003363:Cost Control / Q000706:statistics & numerical data; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009664:Norway; D011364:Professional Practice / Q000706:statistics & numerical data; D012938:Social Perception; D013557:Switzerland; D006113:United Kingdom