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What sort of healthcare does the public expect, want or need?

• Patients want clear explanations of what’s wrong with them and what to expect, both from their condition and from the system. Patients also want to be involved in decisions about their care. They value support and reassurance and want to be treated as individuals. Continuity is also important to their sense of confidence in healthcare providers and the NHS.

• In terms of spending priorities, the most important areas for the public are; facilities, staffing and access to treatment, followed by health promotion and preventative measures. The public consider employment, and quality of education to be fundamentally important to health. The public also support resources being allocated to what they see as areas of unmet need, such as people with psychiatric illness in the community and homelessness.

• There is widespread support for the principle of equity and most people have a genuine concern for the welfare of others.

• The public is against limiting provision of services on the basis of cost and would support treatment even when prognosis is limited, for example in the case of premature babies or people with cancer. With the exception of drug misusers, they are also against limiting on the basis of cause of illness. The public are nonetheless aware of pressure on resources and in some cases are open to excluding those things which are so inexpensive they can be easily afforded by most people.

• Although people are taking more responsibility for meeting their own needs, they still support the provision and expansion of state welfare services. Most people support higher taxes and increased spending on health, although this is not the same as voting for a political party who want to raise taxes.

• It has been suggested that government policy should not assume that people are basically self interested. Rather policy should be designed to appeal to people’s self interest and to their sense of altruism. It is hoped that this report provides a useful starting point for a review of healthcare funding in the UK

Introduction
As part of the BMA review of UK healthcare funding, a literature review was undertaken with the aim of answering the following question:

What sort of healthcare does the public expect, want or need?
The MEDLINE and Kings Fund library databases were used to search for literature and relevant citations in retrieved articles were followed up. Reports from relevant bodies, conference proceedings and other types of ‘grey’ literature were also sought. The methodological quality of research was assessed prior to inclusion. Where possible public opinion data was restricted to that collected after 1997 and ‘deliberative’ research (where respondents had access to information and time to consider the issue) was favoured over spontaneous polls, although the latter were included where no other information could be readily found. Only that research which was conducted in the UK was examined.

The breadth of the topic does not allow for a systematic review of all literature published on the subject. Instead the intention is to provide an overview of recent studies with the aim of informing the direction of future research.