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Will elderly patients stand aside for younger patients in the queue for cardiac services?

Mariotto A, De Leo D, Buono MD, Favaretti C, Austin P, Naylor CD. Lancet. 1999; 354(9177):467-70.

Background — Fair management of queues for hospital-based services requires consideration of clinical need, but there is no information on public attitudes towards non-clinical factors such as age or work status as determinants of priority.

Methods — We asked elderly residents of Padova, Italy, whether, if they were awaiting cardiac surgery or an outpatient cardiology consultant, they would give up their place in line for a younger or self-employed individual. We also elicited responses from a convenience sample of younger health workers asked to imagine themselves as elderly persons facing the same choices.

Findings — The eligible response rate was 72% (443/616). About half deemed it right to give up their place in line for cardiac surgery to a 45-year-old (51%, 95% CI 46–56) or self-employed person (47%, 95% CI 42–51) Proportions were significantly higher for an outpatient consultation (68%, 95% CI 63–72). In multivariate analyses, married respondents, those closer to age 65, university graduates, and those who were formerly self-employed were significantly less likely to respond affirmatively. In significant contrast for all four scenarios (p<0·0001), the overwhelming majority of non-elderly respondents refused to give up their places in line.

Interpretation — The majority of elderly citizens were hypothetically willing to cede priority in accessing cardiac care to younger or self-employed persons, but this willingness was attenuated among the “young” elderly and more privileged respondents. Non-elderly respondents were much less self-sacrificing, suggesting that ageing babyboomers may be more assertive about their continuing rights to health care.

Keywords: Social determinants of health Access to health care Cardiovascular diseases