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Public preferences for allocating absolute scarce critical healthcare resources during the COVID-19 pandemic

Micaela Pinho (Research on Economics, Management and Information Technologies (REMIT), Portucalense University, Porto, Portugal) (Portucalense Institute for Legal Reseach (IJP), Porto, Portugal) (Research Unit in Governance, Competitiveness and Public Policies (GOVCOPP), University of Aveiro, Aveiro, Portugal)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 25 May 2021

Issue publication date: 13 October 2021




This paper aims to investigate the Portuguese general public views regarding the criteria that should guide critical COVID-19 patients to receive medical devices (ventilators and IUC beds) during the current pandemic context. Based on rationing principles and protocols proposed in ethical and medical literature the authors explore how Portuguese general public evaluates the fairness of five allocation principles: “prognosis”, “severity of health condition”, “patients age”, “instrumental value” (frontline healthcare professionals should be prioritized during the pandemic) and “lottery”.


An online questionnaire was used to collect data from a sample of 586 Portuguese citizens. Descriptive statistics and non-parametric tests were used to define a hierarchy of prioritization criteria and to test for the association between respondents support to them and their socio-demographic and health characteristics.


Respondents gave top priority to prognosis when faced with absolute scarcity, followed closely by the severity of health condition, patient’s age with instrumental value receiving lowest support, on average. However, when the age of the patients was confronted with survival, younger-first principle prevailed over recovery. In a pandemic context, lottery was considered the least fair allocation method. The findings suggest that respondents’ opinions are aligned with those of ethicists but are partially in disagreement with the protocol suggested for Portugal.


This study represents the first attempt to elicit public attitudes towards distributive criteria during a pandemic and, therefore, in a real context where the perception is that life and death decisions have to be made.



The author grateful to all those who voluntarily completed the survey and thus contributed to the realization of this work.

Disclosure Statements: The author declare no potential conflict of interest with respect to the research, authorship and/or publication of this article. The author disclosed receipt of any financial support for the research, authorship, and/or publication of this article.


Pinho, M. (2021), "Public preferences for allocating absolute scarce critical healthcare resources during the COVID-19 pandemic", Journal of Health Organization and Management, Vol. 35 No. 8, pp. 964-986.



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