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      "Saying no is no easy matter" A qualitative study of competing concerns in rationing decisions in general practice

      research-article
      1 , , 2
      BMC Health Services Research
      BioMed Central

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          Abstract

          Background

          The general practitioner in Norway is expected to ensure equity and effectiveness through fair rationing. At the same time, due to recent reforms of the Norwegian health care sector, both the role of economic incentives and patient autonomy have been strengthened. Studies indicate that modern general practitioners, both in Norway and in other countries are uncomfortable with the gatekeeper role, but there is little knowledge about how general practitioners experience rationing in practice.

          Methods

          Through focus group interviews with Norwegian general practitioners, we explore physicians' attitudes toward factors of influence on medical decision making and how rationing dilemmas are experienced in everyday practice.

          Results

          Four major concerns appeared in the group discussions: The obligation to ration health care, professional autonomy, patient autonomy, and competition. A central finding was that the physicians find rationing difficult because saying no in face to face relations often is felt uncomfortable and in conflict with other important objectives for the general practitioner.

          Conclusion

          It is important to understand the association between using economic incentives in the management of health care, increasing patient autonomy, and the willingness among physicians to contribute to efficient, fair and legitimate resource allocation.

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          Most cited references46

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          Patient-centredness: a conceptual framework and review of the empirical literature.

          A 'patient-centred' approach is increasingly regarded as crucial for the delivery of high quality care by doctors. However, there is considerable ambiguity concerning the exact meaning of the term and the optimum method of measuring the process and outcomes of patient-centred care. This paper reviews the conceptual and empirical literature in order to develop a model of the various aspects of the doctor-patient relationship encompassed by the concept of 'patient-centredness' and to assess the advantages and disadvantages of alternative methods of measurement. Five conceptual dimensions are identified: biopsychosocial perspective; 'patient-as-person'; sharing power and responsibility; therapeutic alliance; and 'doctor-as-person'. Two main approaches to measurement are evaluated: self-report instruments and external observation methods. A number of recommendations concerning the measurement of patient-centredness are made.
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            InterViews : An Introduction to Qualitative Research Interviewing

            Interviewing is an essential tool in qualitative research and this introduction to interviewing outlines both the theoretical underpinnings and the practical aspects of the process. After examining the role of the interview in the research process, Steinar Kvale considers some of the key philosophical issues relating to interviewing: the interview as conversation, hermeneutics, phenomenology, concerns about ethics as well as validity, and postmodernism. Having established this framework, the author then analyzes the seven stages of the interview process - from designing a study to writing it up.
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              The Problem of Informant Accuracy: The Validity of Retrospective Data

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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                2005
                9 November 2005
                : 5
                : 70
                Affiliations
                [1 ]Health Economics, Bergen, Stein Rokkan Centre for Social Studies, The University of Bergen, Nygårdsgaten 5, 5015 Bergen, Norway
                [2 ]Professor, The Department of Public Health and Primary Health Care, Section for General Practice, The University of Bergen, Kalfarveien 31, 5018 Bergen, Norway
                Article
                1472-6963-5-70
                10.1186/1472-6963-5-70
                1291367
                16281967
                d36df72d-5a79-43a2-bd85-f6635f88d765
                Copyright © 2005 Carlsen and Norheim; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 April 2005
                : 9 November 2005
                Categories
                Research Article

                Health & Social care
                Health & Social care

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