Relevanz und finanzierung von gesundheitsleistungen: Eine befragung von ärzten, studenten, patienten, pflegepersonal und senioren

Background: In Germany public opinion is increasingly in favour of being included in decisions on priority and rationalisation of health care, as practised in other countries for years. One question is, which influence medical know-how and patients' experience have on the assessment of health services (importance or reimbursement of expenses). In addition to a representative survey it would be appropriate to include certain groups like physicians, medical students, nursing staff, patients and inhabitants of old people's homes in a relevant survey. Design: We conducted a survey of six groups, differing in medical know-how, personal affliction and age, by a highly standardized questionnaire. The group of physicians received the questionnaire by mail with one reminder. The questionnaire was handed out to the other groups (directly). Setting: 150 practices of internal specialists and general practitioners in and around Lübeck, a preclinical and a clinical semester of the Medical University of Lübeck, an old people's home in Lübeck-Travemünde and a cardiological clinic for rehabilitation in Bad Segeberg. Subjects: 150 practising physicians (internal specialists, general practitioners), 100 medical students of a preclinical semester and another 100 of the fifth clinical semester, 100 patients in cardiological consulting hours in a cardiological clinic, 100 members of the nursing staff of the same clinic and 110 residents in an old people's home. The survey period was between December 1997 and February 1998. Instrument: The questionnaire was identical to a parallel public survey. On the one hand defined health services were assessed in respect of importance and reimbursement of expenses. On the other hand, more general questions were asked regarding possible ways of financing or economization in public health. Results: A response rate of 82% was achieved in the group of inhabitants of the old people's home. Doctors and students showed a response rate between 60% and 70%, while the response rate of patients and nursing staff was about 50%. A clear agreement between groups could be found in the evaluation of health services in the case of severe illnesses of children, which achieved the highest rating. The evaluation of health services of controversial effectivity like homoeopathic drugs or acupuncture varied most. There was a tendency in the patients' group to rate the importance of the listed health services higher than in the other groups, especially doctors and clinical students. All groups showed readiness to assign more financial consequences to patients with illnesses caused by the patient's behaviour, e.g. dangerous forms of sports or smoking. Conclusion: Laity as well as experts showed a distinct interest in the complex subject. Medical know-how goes along with a more critical evaluation of the importance of numerous indications. Patients distinguished less between different health services. The questionnaire showed that those directly concerned wish to be included in the discussion and feel that decisions concerning priority-setting in public health should not be left to politicians and health insurance companies alone.