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Age as a criterion for priority setting in health care services? Adele Diederich Jeannette Winkelhage, Margrit Schreier Jacobs University Bremen, Germany.

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Presentation on theme: "Age as a criterion for priority setting in health care services? Adele Diederich Jeannette Winkelhage, Margrit Schreier Jacobs University Bremen, Germany."— Presentation transcript:

1 Age as a criterion for priority setting in health care services? Adele Diederich Jeannette Winkelhage, Margrit Schreier Jacobs University Bremen, Germany Priorities 2010, April 23-25, Boston, Massachusetts USA

2 Overview Background Methods Results Boston, April 24, Diederich et al.

3 Boston, April 24, 2010 Background Ongoing debate on setting priorities in health care in many countries for many years Implementation of principles and guidelines in several years Not so in Germany 3 Diederich et al.

4 How much are we spending on our health? Boston, April 24, 2010Diederich et al. 4

5 Heath Expenditure Boston, April 24, 2010Diederich et al. 5 Germany spends approx. 10.5% of its gross domestic product (GDP) on health. USA Switzerland France Germany

6 Population and Health Care Expenditure Boston, April 24, 2010Diederich et al year olds  16.6% of population  36.3% of health care expenditure

7 Boston, April 24, 2010 Research Questions Does the public accept age as a criterion for priority setting in health care services? Are there any differences in preference depending on the person’s own age, sex, socioeconomic status, or health status? 7 Diederich et al.

8 Boston, April 24, 2010 Methods Qualitative study with different stakeholders (health care providers, healthy citizens, patients, physicians, politicians, representatives of health care insurances) Survey (CAPI) with 135 items, seven focusing on age as a possible criterion for priority setting (6 Conjoint Analysis elements) Elderly Children Middle aged Specific scenarios 8 Diederich et al.

9 Sample N = 2031 Age: (18 to > 79 years) Sex: 44.3% male, 55.7% female Socioeconomic status: 50.2% low 39.1% middle 10.7% high Boston, April 24, Diederich et al.

10 Evaluation Contingency tables Logistic models with age, socioeconomic status, sex, physical health status (SF8) and mental health status (SF8) as factors Boston, April 24, Diederich et al.

11 Boston, April 24, 2010 Results Elderly Do you think it is justifiable to treat elderly patients in preference to all others? YesNoNo answer Number (percentage) 1019 (50.3) 923 (45.4) 89 (4.3) 11 Diederich et al.

12 Results Elderly Boston, April 24, 2010 p = Diederich et al.

13 Boston, April 24, 2010 Results Children Do you think it is justifiable to treat children in preference to all others? YesNoNo answer Number (percentage) 1472 (72.5) 516 (25.4) 43 (2.1) 13 Diederich et al.

14 Results Children Boston, April 24, 2010 p= Diederich et al.

15 Comparison Elderly Children Boston, April 24, 2010 YesNoNo answer Number (percentage) 1019 (50.3) 923 (45.4) 89 (4.3) YesNoNo answer Number (percentage) 1472 (72.5) 516 (25.4) 43 (2.1) Both YesBoth NoYes/no Number (percentage) 855 (44.8) 359 (18.8) 695 (36.4) 15 Diederich et al.

16 Comparison Boston, April 24, 2010 p= Diederich et al.

17 Boston, April 24, 2010 Results Middle Aged Do you consider it justified to offer persons of working age a preferential treatment compared to all others? YesNoNo answer Number (percentage) 292 (14.4) 1699 (83.6) 40 (2.0) 17 Diederich et al.

18 Results Middle Aged Boston, April 24, 2010 p= Diederich et al.

19 Results Binary Logistic regression Main effects Elderly Socioeconomic status Children Socioeconomic status Sex 2-way Interactions: Elderly Age group and physical health Age group and social economic status Children Age group and socioeconomic status Age group and Sex Boston, April 24, Diederich et al.

20 Boston, April 24, 2010 Results Treatment Order 1 Imagine two patients are life-threatening ill, but only one treatment can be offered at the moment. Which patient should be treated first? The younger patient The 30 years older patient LotteryNo answer Number (percentage) 538 (26.5) 380 (18.7) 416 (20.5) 697 (34.4) 20 Diederich et al.

21 Results Treatment Order 1 Boston, April 24, 2010 p= Diederich et al.

22 Boston, April 24, 2010 Results Treatment Order 2 n = 1493 Assume, the older patient is very old. Which decision do you agree with? The younger patient is treated The older patient is treated LotteryNo answer Number (percentage) 258 (17.3) 324 (21.7) 405 (27.1) 506 (33.9) 22 Diederich et al.

23 Results Treatment Order 2 Boston, April 24, 2010 p= Diederich et al.

24 Boston, April 24, 2010 Results Age Limit Suppose, Germany sets a legal age limit concerning dialysis treatments for patients suffering from a nephropathy disease. The treatment is not covered anymore by health insurance for patients beyond a certain age. Which statement do you agree with? Exception for good general health condition Independent of the general health condition - no exception No answer Number (percentage) 1242 (61.2) 387 (19.1) 402 (19.8) 24 Diederich et al.

25 Results Age Limit Boston, April 24, 2010 p= Diederich et al.

26 Boston, April 24, 2010 Results Emergency Scenario: There are numerous injured persons after a fire, but not enough assistants on site. If you were the responsible doctor, would you treat younger patients prior to older patients? YesNoNo answer Number (percentage) 574 (28.3) 1086 (53.5) 271 (18.3) 26 Diederich et al.

27 Results Emergency Boston, April 24, 2010 p= Diederich et al.

28 Boston, April 24, 2010 Results Organ Allocation To what extent do you agree with the following statements on organ allocation? Younger patients should be preferred over older patients. Completely agree Rather agree Rather not agree Not agree at all No answer Number (percentage) 322 (15.9) 476 (23.4) 534 (26.3) 496 (24.4) 203 (10.0) 28 Diederich et al.

29 Results Organ Allocation Boston, April 24, 2010 p= Diederich et al.

30 Results MNL ScenarioMain Effects2-Way Interaction Treatment Order 1SocioeconomicAge and Socioeconomic Treatment Order 2SocioeconomicAge and Socioeconomic, Mental Age LimitSocioeconomicAge and Socioeconomic, Mental Sex and Physiological EmergencySocioeconomicSex and Mental AgeAge and Socioeconomic SexAge and Sex Organ AllocationMentalMental and Socioeconomic, Age, Sex, Physiological Socioeconomic and Age, Sex, Physiological Age and Sex, Physiological Physiological and Sex Boston, April 24, Diederich et al.

31 Boston, April 24, 2010 Summary and Conclusion Elderly preferred to all other Children preferred to all other Middle aged not preferred Socioeconomic status most important factor to discriminate between groups In general, prioritizing health services according to ‘age’ is not accepted. However, the preference changes depending on specific context and framing. 31 Diederich et al.

32 Boston, April 24, 2010 Thank You Contact: 32 Diederich et al.


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