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Fastlegenes dilemma: Pasientvelferd eller kostnadshensyn?

julie.riise@econ.uib.no

Postdoktor, Institutt for økonomi, Universitetet i Bergen

benedicte.carlsen@uni.no

Forsker 1, Uni Rokkansenteret

Samfunnsplanleggeren vil typisk ønske å holde kostnadene i helsevesenet under kontroll slik at det også finnes penger til andre gode formål. Pasienten vil på den annen side ønske å få den best mulige behandlingen, uavhengig av hva den koster. Hva hver enkelt lege beslutter i møte med sine pasienter, er avgjørende for den faktiske prioriteringen i helsevesenet. Denne artikkelen handler om hvordan norske fastleger forholder seg til disse motsetningene i praksis.

Patient welfare or cost consideration: General practitioners' dilemma

Prioritisation and rationing in the health sector is of great current interest and an increasingly debated issue. Norwegian doctors advocates for taking their territory back, and for increased autonomy in clinical decision making. On this backdrop we ask; what would the consequence of such an initiative be for implicit prioritisation through clinical choices? Available literature provides little insight into medical doctors' clinical choices when they are required to make complex trade-offs between different concerns simultaneously. We investigate this through a discrete choice experiment conducted with 284 Norwegian general practitioners, capturing preferences for medications described along five dimensions important for both clinical decision-making and prioritisation in the health sector. Effectiveness is the most important determinant of choice in our study, but considerable weight is also put on patients' preferences and on avoiding high total costs. Although there is considerable heterogeneity in the results, it turns out that on average GPs are willing to make difficult trade-offs between concerns they are often assumed not to be willing to compromise on, like effectiveness, patient preferences, or cost measures - given that they have proper information about these attributes.

Keywords: Norway, GPs, prescription behaviour, patient preferences, cost-effectiveness, prioritisation in health, discrete choice experiment
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