Distributed resources and care choice: formulation through the capability approach

Background: Facing the problem of healthcare resource distribution under a severe healthcare budget constraint, care providers or healthcare authorities are strongly required to cut costs, which could deter individuals from applying for certain types of care services. The study aims to clarify the differences in resources distributed to individuals by formulating empirical data on patients through the capability approach, with a special focus on the opportunity and process aspects of freedom while utilising care services. Methods: A process aspect of freedom is captured by patients’ decision making for care services (DM), while an opportunity aspect of freedom is by accessing social services (SS). Distributed resources, nursing services offered to patients, are assumed to be converted to DM and SS through each individual’s utilisation ability of resources for DM and SS. A patient chooses an achievement point (a combination of DM and SS) within her budget set under her evaluation function of ‘well recuperation’. Achievement in DM and SS and ‘well recuperation’ were studied through a questionnaire survey on 116 patients hospitalised at general acute wards in Sweden. Individuals were asked about their physical and mental constraints toward daily living activities through an EQ-5D-3L questionnaire (specifically to examine the dimensions of ‘pain’ and ‘anxiety’). Results: The formulated choice set suggested that patients with constraints are less likely to achieve DM than those without any constraints. When individual evaluation is accounted for, the largest amount of resources is distributed to patients with physical and mental constraints, followed by those with physical constraints and those with no constraints. Conclusions: The formulation through a capability approach, supported by empirical data, shows that physical and mental constraints of patients’ can restrict their choice set with respect to the process aspect of freedom of care service utilisation. Key messages: Capability approach can provide a theoretical background and empirical evidence to justify resource distribution in healthcare, accounting for individual differences in physical or mental conditions Patients with physical or mental constraints have a restricted choice set with respect to the process aspect of freedom of care service utilisation despite additional resource distribution