Setting priorities for high-cost medications in public hospitals in Australia: Should the public be involved?

Aim. To explore healthcare decision makers' perceptions about public involvement in setting priorities for high-cost medications (HCMs) in public hospitals in Australia. Methods. In-depth, semi-structured interviews were conducted with 24 decision-makers (executive directors of hospitals, area health service managers, directors of hospital pharmacy departments and senior medical doctors) in a Sydney Area Health Service. Interviews were digitally recorded, transcribed verbatim, thematically content analysed and coded. Results. The majority of participants perceived that the 'rationing debate' needs to happen in Australia. The community at large should be encouraged to understand that healthcare resources are limited and choices need to be made. The perspectives of the public, according to participants, were considered diverse (tax payers, patients, consumers). Owing to the complexities of the healthcare system, their involvement of the public in decision-making regarding access to HCMs in public hospitals was considered limited. For participants, the role of the public was likely to be at the macro level, deciding how much they were prepared to spend on healthcare. Conclusion. The role of the public in setting priorities for HCMs in public hospitals was perceived by these healthcare decision makers as limited. However since rationing is unavoidable, there should be an explicit debate about the principles and issues concerned. What is known about the topic? Recognition of the importance of engaging the public in healthcare decision making is increasing. However, there is only limited understanding of the role of citizens in current priority setting mechanisms for allocating scarce resources to high-cost technologies such as medications at the public hospital level. What does this paper add? This study describes how involving the public in setting priorities for HCMs can present specific challenges from the perspective of decision makers working in the public hospital system. What are the implications for practitioners? In a time when public awareness is increasing about medical advances the challenge is to find ways of informing and involving the public in the debate about the distribution of healthcare resources. The results from this study will be useful for policy makers working on ways to improve the legitimacy of decisions at the institutional level. © 2011 AHHA