Investing in early detection versus intensive treatment for breast cancer: A study of the Israeli public priorities

Objective: Public opinion has become one of the main inputs in setting priorities, rationing and allocating health resources. The present study focuses on the priorities of the Israeli public in allocating marginal breast cancer funds between early detection in the healthy majority of the population and intensive treatment of the sick minority in need. Design: A sample of 2030 individuals representing the Israeli Jewish urban population aged 45-75 was interviewed in 1993/4. A full sit-down interview collected information on several health related issues. Results: Sixty-one per cent chose to direct the funds to early detection efforts and 35% chose to direct the funds to treating the sick. Four per cent of the population could not decide. Higher education and better health are related to choosing early detection; religious observance is related to choosing the treatment option; and men and older persons tend, more than women and younger respondents, to be undecided. Conclusions: Whilst the majority of the population tend to follow a cost-effectiveness rationale in the marginal use of breast cancer funds, for more than a third of the population efficiency is not thus important, and they adhere to entitlement based upon a need-equity principle in allocating health resources.