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Holding individuals accountable for engaging in harmful health behaviours when managing scarce resources: Yes or not really?

Micaela Pinho (Research on Economics, Management and Information Technologies (REMIT) & Portucalense Legal Institute (IJP), Universidade Portucalense, Porto, Portugal) (Research Unit in Governance, Competitiveness and Public Policies (GOVCOPP), University of Aveiro, Porto, Portugal)
Ana Pinto Borges (ISAG – European Business School and Research Group of ISAG (NIDISAG), Porto, Portugal)

International Journal of Health Governance

ISSN: 2059-4631

Article publication date: 25 July 2019

Issue publication date: 1 August 2019




The purpose of this paper is to investigate the views of Bulgarian citizens about the relevance of lifestyles in the management of scarce resources through rationing and explore whether they are associated with participants’ characteristics.


A self-administered questionnaire was used to collect data from a sample of 322 Bulgarian respondents. Respondents faced a hypothetical rationing scenario where they have to decide whether information about five harmful health behaviours (smoking, excess alcohol consumption, illegal drug use, overeating/poor diet and engaging in dangerous driving (speeding and/or under the influence of alcohol and/or drugs)) should be relevant in priority setting decisions. Descriptive statistics and logistic regressions were performed.


The majority of respondents disagree with the idea that personal responsibility for illness should count in priority decisions. Notwithstanding, there seems to be a wider consensus in giving lower priorities to patients that engage in dangerous driving (excess of speed and/or under the influence of alcohol and/or drugs), illegal drugs use and excessive alcohol intake. Overeating/poor quality nutrition was the risky behaviour less condemned by respondents followed by smoking. Respondents’ sociodemographic, health and beliefs about rationing criteria had different impact in the penalization of the risk behaviours.


This study is the first attempt to awaken attention to the impact that personal responsibility for health may have on intergenerational access to healthcare.



Pinho, M. and Borges, A.P. (2019), "Holding individuals accountable for engaging in harmful health behaviours when managing scarce resources: Yes or not really?", International Journal of Health Governance, Vol. 24 No. 3, pp. 206-221.



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