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US neurologists

Attitudes on rationing

From the Department of Neurology and the Department of Community and Preventive Medicine (Dr. Holloway), University of Rochester School of Medicine and Dentistry, NY; the Department of Neurology (Dr. Ringel), University of Colorado Health Sciences Center, Denver; the Neurology Section (Dr. Bernat), Dartmouth Hitchcock Medical Center, Lebanon, NH; and the American Academy of Neurology (C. Keran and B. Lawyer), St. Paul, MN.

Address correspondence and reprint requests to Dr. Robert G. Holloway, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14620-3917.

OBJECTIVE: To assess neurologists’ attitudes on rationing health care and to determine whether neurologists would set healthcare priorities in ways that are consistent with cost-effectiveness research.

BACKGROUND: Cost-effectiveness research can suggest ways to maximize health benefits within fixed budgets but is currently being underused in resource allocation decisions.

METHODS: The authors surveyed a random sample of neurologists practicing in the United States (response rate, 44.4%) with three hypothetical scenarios. Two scenarios were designed to address general attitudes on allocating finite resources with emphasis on formulary decisions for costly drugs. The third scenario was designed to assess whether neurologists would optimize the allocation of a fixed budget as recommended by cost-effectiveness analysis.

RESULTS: Three-quarters of respondents thought that neurologists make daily decisions that effectively ration healthcare resources, and 60% felt a professional responsibility to consider the financial impact of individualized treatment decisions on other patients. Only 25% of respondents thought that there should be no restrictions placed on any of the five newer antiepileptic agents. In a 1995 survey, 75% of similarly sampled neurologists agreed that no restrictions should be placed on the availability of FDA-approved medications. Nearly half (46%) of respondents favored a less effective test and would be willing to let patients die to ensure the offering of a more equitable alternative.

CONCLUSIONS: Most neurologists recognize the need to ration health care, and although they think cost-effectiveness research is one method to achieve efficient distribution of resources, many think that considerable attention should also be given to equity.–1497

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