title: A four-country survey of public attitudes towards restricting healthcare costs by limiting the use of high-cost medical interventions.
abstract: OBJECTIVE
  To discern how the public in four countries, each with unique health systems and cultures, feels about efforts to restrain healthcare costs by limiting the use of high-cost prescription drugs and medical/surgical treatments.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Adult populations in Germany, Italy, the UK and the USA.
  
  
  METHODS
  2517 adults in the four countries. A questionnaire survey conducted by telephone (landline and cell) with randomly selected adults in each of the four countries.
  
  
  METHODS
  Support for different rationales for not providing/paying for high-cost prescription drugs/medical or surgical treatments, measured in the aggregate and using four case examples derived from actual decisions. Measures of public attitudes about specific policies involving comparative effectiveness and cost-benefit decision making.
  
  
  RESULTS
  The survey finds support among publics in four countries for decisions that limit the use of high-cost prescription drugs/treatments when some other drug/treatment is available that works equally well but costs less. The survey finds little public support, either in individual case examples or when asked in the aggregate, for decisions in which prescription drugs/treatments are denied on the basis of cost or various definitions of benefits. The main results are based on majorities of the public in each country supporting or opposing each measure.
  
  
  CONCLUSIONS
  The survey findings indicate that the public distinguishes in practice between the concepts of comparative effectiveness and cost-effectiveness analysis. This suggests that public authorities engaged in decision-making activities will find much more public support if they are dealing with the first type of decision than with the second.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Blendon
authors.forename: John M
authors.initials: JM
authors.lastname: Benson
authors.forename: Michael D
authors.initials: MD
authors.lastname: Botta
authors.forename: Deborah
authors.initials: D
authors.lastname: Zeldow
authors.forename: Minah Kang
authors.initials: MK
authors.lastname: Kim