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It takes a giraffe to see the big picture – Citizens view on decision makers in health care rationing.pdf

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It takes a giraffe to see the big picture – Citizens view on decision makers in health care rationing.pdf

Social Science Medicine 128 (2015) 301e308 Contents lists available at ScienceDirect Social Science Medicine journal homepage: /locate/socscimed It takes a giraffe to see the big picture e Citizens view on decision makers in health care rationing Mari Broqvist*, Peter Garpenby Department of Medical and Health Sciences, The National Centre for Priority Setting in Health Care, Linko€ping University, Linko€ping, Sweden article info Article history: Available online 27 January 2015 Keywords: Sweden Health care Rationing Programme level Decision maker Citizens view Interview Phenomenography abstract Previous studies show that citizens usually prefer physicians as decision makers for rationing in health care, while politicians are downgraded. The ?ndings are far from clear-cut due to methodological differences, and as the results are context sensitive they cannot easily be transferred between countries. Drawing on methodological experiences from previous research, this paper aims to identify and describe different ways Swedish citizens understand and experience decision makers for rationing in health care, exclusively on the programme level. We intend to address several challenges that arise when studying citizens views on rationing by (a) using a method that allows for re?ection, (b) using the respondents nomination of decision makers, and (c) clearly identifying the rationing level. We used phenomenography, a qualitative method for studying variations and changes in perceiving phenomena. Open-ended interviews were conducted with 14 Swedish citizens selected by standard criteria (e.g. age) and by their attitude towards rationing. The main ?nding was that respondents viewed politicians as more legitimate decision makers in contrast to the results in most other studies. Interestingly, physicians, politicians, and citizens were all associated with some kind of risk related to self-interest in relation to rationing. A collaborative solution for decision making was preferre