Age as a criterion for priority setting in health care services?

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 Diederich et al.

3. 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 Diederich et al.

4. Howmucharewespending on ourhealth? Diederich et al.

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

6. Population andHealth Care Expenditure 65 - 84 year olds  16.6% of population  36.3% of health care expenditure Diederich et al.

7. 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? Diederich et al.

8. 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 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 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 Diederich et al.

11. Results Elderly Do you think it is justifiable to treat elderly patients in preference to all others? Diederich et al.

12. Results Elderly p = 0.042 Diederich et al.

13. Results Children Do you think it is justifiable to treat children in preference to all others? Diederich et al.

14. Results Children p=0.714 Diederich et al.

15. Comparison • Elderly • Children Diederich et al.

16. Comparison p=0.543 Diederich et al.

17. Results Middle Aged Do you consider it justified to offer persons of working age a preferential treatment compared to all others? Diederich et al.

18. Results Middle Aged p=0.208 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 Diederich et al.

20. 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? Diederich et al.

21. Results Treatment Order 1 p=0.005 Diederich et al.

22. Results Treatment Order 2 n = 1493 Assume, theolderpatientisveryold. Which decision do you agree with? Diederich et al.

23. Results Treatment Order 2 p=0.447 Diederich et al.

24. 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? Diederich et al.

25. Results Age Limit p=0.016 Diederich et al.

26. 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? Diederich et al.

27. Results Emergency p=0.000 Diederich et al.

28. Results Organ Allocation To what extent do you agree with the following statements on organ allocation? Younger patients should be preferred over older patients. Diederich et al.

29. Results Organ Allocation p= 0.069 Diederich et al.

30. Results MNL Diederich et al.

31. 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. Diederich et al.

32. Thank You Contact: a.diederich@jacobs-university.de Diederich et al.