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Older People’s Reasoning About Age Related Prioritization in Healthcare

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Werntoft, E., Hallberg, I., and Edberg, A.(2007). Older People’s Reasoning About Age Related Prioritization in Healthcare. Nursing Ethics 14 (3), 399-412. DOI

Older People’s Reasoning About Age Related Prioritization in Healthcare
Healthcare Policy, Law, and Ethics
July 22, 2011

Introduction Elderly people are a diverse group regarding age, socioeconomic factors, health status and experience of health care. Older people views on age-related prioritization in health care are likely to contrast. The number of older people has enlarged and so has the use of costly treatments and medicines. However the healthcare cost for people who are eighty five and older has gone down at the time this article was written. In Sweden, they passed a law that states regardless of age, everyone has equal access to health services. Prioritization in healthcare is not unique. It happens frequently when resources are inadequate and diverse treatments will become greater in demand. The purpose of this study was to describe the reasoning of people aged 60 years and over about prioritization in health care with regard to age and willingness to pay. In Sweden, the Swedish Parliamentary Priority Commission was based on three ethical principles: the principle of human dignity, the principle of need and solidarity, and the cost-efficiency principle. Many feel that age should be criteria in the prioritization process. The study discusses the fair innings perspective. The fair innings perspective say the there is a duration of years that is considered a reasonable life or a fair innings and obliges that everyone should be given an equal chance to have a fair innings to reach the suitable age but, having achieved it, they have received their entitlement. The other perspective is the age relative opportunity range. This perspective allocates healthcare cost over an individual’s lifetime. This allows an individual to save resources from their early years and use them in their later years. The final perspective in out of pocket payments vs. waiting lists; the study revealed that the older an individual was the more likely they wanted to be on that waiting list.
Methods
This study included 446 participants from five municipalities in southern Sweden. The participants ranged from ages 60 to 101 years of age. This group was broken up into two groups. The first group was randomly chosen to explain the ageing process from varying points of view. The age for this group was 60 to 93. The second group’s focus was on care and service. Many in this group were receiving continuous care and home services. The age for this group was 65 and over. To collect the data a questionnaire was used. Also during the interview process the participants were recorded. These recording were then transcribed word for word.
Results
The results in this study about prioritization in healthcare were based on personal experience. However, many in the study sense that everyone should be treated in order of succession, while some of the others acknowledged the need for prioritization for the most severely ill patients. Many of the elderly participants also felt that it was imperative that it be organized. Their opinions were place into eight categories. The categories were: feeling secure and confident in the health care system, being old means low priority, prioritization causes worries, using underhand means in order to be prioritized, prioritization as a necessity, being averse to anyone having precedence over others, having doubts about the distribution of resources, and buying treatment requires wealth. In the interviews people said that their felt secure and confident when their need were met. Next some of the interviewees said that because they were old, their treatments and exams were low priority in comparison to younger people. The elderly worried about helplessness and not having someone to fight for them. Because of this many admitted to using less than honest ways of getting healthcare. During some of the interviews some said that if someone is extremely sick, they should be seen as soon as possible. Therefore prioritization is imperative.
Discussion
There were opposing experiences and opinions about the prioritization of Swedish healthcare. The more positive opinions came from individuals who were not consistently ill and at the younger end of the sample group. While the negative opinions came from the individuals who were terminally ill, lacked family and funds to expedite treatment. The participants did not trust some of the politicians or the healthcare workers. They felt that paying to take precedence was further seen as morally wrong and unfair to other people waiting for treatment.
Critique
It is my opinion that prioritization in healthcare could not work in the United States. This is my viewpoint because currently people who are extremely ill, no family or someone to care for them, and lack of wealth struggle to get healthcare. The government wants to eliminate the programs that are already set in place to assist the poverty stricken from access to get healthcare. The people who are representing those who are included in that category will never have to worry about accessing healthcare. I do agree with the findings in the study, in that the opinions would be vast based on an individual’s experience, financial status, and family status.

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