Health professionals would prioritize spending on the young over the old

In prioritizing health care spending, health professionals rank childhood immunization highest and cancer treatment for smokers lowest, according to a new international survey published in PLoS Medicine.

The survey found that health professionals generally prioritize spending on the young over the old and on preventive care over curative care. Yet this preference is at odds with the actual spending priorities in most countries throughout the world-most governments spend more on curative than on preventive health care services.

Glenn Salkeld (University of Sydney, Australia) and colleagues surveyed 253 health professionals from six countries, asking them to rank ten health interventions in order of priority for spending from most important (rank 1) to least important (rank 10).

The median rankings of health-care spending priorities across all countries, in order of importance, were:

1. Childhood immunization
2. Anti-smoking education for children
3. General practitioner care for everyday illness 4. Screening for breast cancer 5. Intensive care for neonates 6. Support for carers of the elderly 7. Treatment for people with schizophrenia 8. Hip replacement 9. Heart transplant 10. Cancer treatment for smokers

The values expressed by the health professionals in this study, say Salkeld and colleagues, transcended national and sectoral boundaries.

"Across the world many countries are struggling with the health and financial implications of a rapid rise in non-communicable disease," they say. "If health care professionals and policy makers believe that prevention and targeting the young is an important principle for health spending priorities, then health care funders should examine the cost effectiveness evidence for intervening early in life."

Citation: Salkeld G, Henry D, Hill S, Lang D, Freemantle N, et al. (2007) What drives healthcare spending priorities? An international survey of health-care professionals. PLoS Med 4(2): e94.