To accept, or not to accept, that is the question: citizen reactions to rationing.

BACKGROUND The publicly financed health service in Sweden has come under increasing pressure, forcing policy makers to consider restrictions. OBJECTIVE To describe different perceptions of rationing, in particular, what citizens themselves believe influences their acceptance of having to stand aside for others in a public health service. DESIGN Qualitative interviews, analysed by phenomenography, describing perceptions by different categories. SETTING AND PARTICIPANTS Purposeful sample of 14 Swedish citizens, based on demographic criteria and attitudes towards allocation in health care. RESULTS Participants expressed high awareness of limitations in public resources and the necessity of rationing. Acceptance of rationing could increase or decrease, depending on one's (i) awareness that healthcare resources are limited, (ii) endorsement of universal health care, (iii) knowledge and acceptance of the principles guiding rationing and (iv) knowledge about alternatives to public health services. CONCLUSIONS This study suggests that decision makers should be more explicit in describing the dilemma of resource limitations in a publicly funded healthcare system. Openness enables citizens to gain the insight to make informed decisions, i.e. to use public services or to 'opt out' of the public sector solution if they consider rationing decisions unacceptable.