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.