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Article
Publication date: 18 June 2018

Micaela Pinho, Ana Pinto Borges and Duje Petricevic

The purpose of this paper is to explore Croatian views about issues regarding bedside rationing decisions.

Abstract

Purpose

The purpose of this paper is to explore Croatian views about issues regarding bedside rationing decisions.

Design/methodology/approach

An online questionnaire was used to collect data from a sample of 243 Croatian citizens. In a context of hypothetical scenarios involving priority setting decisions taking by physicians, the present study elicits Croatian respondents’ views concerning: the ethical principles that should guide patients prioritization; the parties that should make prioritization decisions; and the likelihood of healthcare rationing becoming a reality. Descriptive analysis, factor analysis and parametric and non-parametric tests were performed.

Findings

Findings suggest that Croatian respondents: support multiple substantive rationing criteria, with an incident in favoring the worst-off, reducing inequalities in health, translated in the fair-innings argument and efficiency achievement; appoint health professionals as rationing decision makers; and do not seem to believe in the possibility of patient selection becoming a reality.

Practical implications

Favoring the worst-off, equalizing life time health and the pursuit of efficiency seem to be the criteria most preferred by Croatian respondents to guide rationing policy at the micro level.

Originality/value

This study is the first attempt to elicit Croatian opinions concerning several rationing criteria inherent in healthcare micro allocation decisions. Healthcare rationing is a serious challenge to Croatian policy makers and so it would be useful for the public’s perceptions and beliefs to be considered.

Details

International Journal of Human Rights in Healthcare, vol. 11 no. 3
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 21 December 2015

Micaela Pinho and Ana Borges

– The purpose of this paper is to seek to elicit, in a context of economic crisis, the social preferences for the microallocation of scarce healthcare resources.

Abstract

Purpose

The purpose of this paper is to seek to elicit, in a context of economic crisis, the social preferences for the microallocation of scarce healthcare resources.

Design/methodology/approach

Data were collected from an online questionnaire which includes a hypothetical rationing choice scenario with four patients differentiated by their personal characteristics and health states competing for treatments and a set of statements that embodies: distributive criteria for prioritizing patients; the authorship of these types of decisions; and the likelihood of these decisions to be taken. Descriptive statistics, factor analysis and non-parametric test were used for describing and validating the data.

Findings

Findings suggest that respondents: support a pluralism of distributive principles in prioritizing patients with an incident in utilitarianism and the reducing of inequalities in health, translated in the fair-inning and in emotional arguments of fragility; trust in the health professional to make prioritization decisions; and are conscious that rationing decisions will be real in the short term.

Practical implications

The pursuit of efficiency and the equalizing of a lifetime health seem to be the criteria that should guide any rationing policy at the micro level.

Originality/value

This study addresses simultaneously several ethical principles inherent to microallocation healthcare resources in a suitable context in which Portugal is facing an economic crisis and where, consequently, rationing healthcare policies gain prominence on the political agenda.

Details

International Journal of Human Rights in Healthcare, vol. 8 no. 4
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 5 February 2020

Micaela Pinho and Eva Dias Costa

Continuous introduction of advanced health technologies coupled with limited resources force governments to adopt rationing measures in all types of health systems. The…

Abstract

Purpose

Continuous introduction of advanced health technologies coupled with limited resources force governments to adopt rationing measures in all types of health systems. The mass media can influence the application of these measures by rising people and patients' expectations and demands for new forms of healing. This article intends to find evidence of this influence by reporting two recent cases which occurred in Portugal involving two innovative drugs, one for the treatment of hepatitis C and another for type I spinal muscular atrophy. The new drugs were not publicly funded despite promising excellent overall health outcomes because of their high cost and exaggerated burden on national health system (NHS).

Design/methodology/approach

A qualitative research was used to collect information conveyed by the conventional media and social networks.

Findings

After a strong dissemination through conventional and social media of the nonapproved treatments, the drugs swiftly garnered support among the public and triggered remarkable and relentless advocacy efforts. The findings of this paper suggest that society opinions and, by extension, the decision of policy-makers are very susceptible to the influence of the mass media.

Practical implications

New ways of sharing information are changing health research and public health.

Social implications

These stories raise complex tensions and important questions about resource-allocation decisions involving scientific research or innovative medicine. Societal preferences seem very vulnerable to information conveyed by the mass media.

Originality/value

This study is the first attempt to awaken attention to the influence that Portuguese mass media may exercise on future healthcare rationing decisions.

Details

International Journal of Health Governance, vol. 25 no. 1
Type: Research Article
ISSN: 2059-4631

Keywords

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Article
Publication date: 1 November 2011

Hengameh Hosseini

As a result of the aging of American society, health care costs have been and will continue to rise, to the extent that they are not sustainable. Obviously, this trend…

Abstract

Purpose

As a result of the aging of American society, health care costs have been and will continue to rise, to the extent that they are not sustainable. Obviously, this trend will continue in spite of the 2010 health care reform. As a result of this uncontrollable problem, writers such as Daniel Callahan have proposed age‐based rationing of health care while utilizing the utilitarian notions of ethics and justice. However, other writers, utilizing more egalitarian notions of justice, have opposed this. This suggests an ethical dilemma, which has to be debated in the future. The author believes professors teaching health care related courses will be instrumental in this debate, explaining why she decided to seek the opinion of a sample of 18 professors regarding this issue. The purpose of this paper is to report on the results of this research.

Design/methodology/approach

Qualitative methodology, specially grounded theory, was used in this study that sought to explore the views of 18 full‐time professors who teach health care policy and administration in Northeast Pennsylvania about age‐based rationing of health care. Qualitative research is very useful uncovering the views of individuals as they relate to their experiences. In the study, professors were asked 14 questions by the author, four of these being demographic. The remaining ten questions, open ended ones, sought the opinions of these professors about their support or opposition to age‐based rationing.

Findings

The author's interviews of those 18 professors and the analysis of the responses, which revealed the complexity and multidimensional nature of the issue, led to the emergence of eight different themes.

Originality/value

The author used a qualitative method of research, interviewing 18 professors, to uncover personal views not previously published.

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Article
Publication date: 13 November 2020

Micaela Pinho

The current COVID-19 pandemic stressed the importance of discussing the problems surrounding the scarcity of healthcare resources. Healthcare rationing has been a constant…

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Abstract

Purpose

The current COVID-19 pandemic stressed the importance of discussing the problems surrounding the scarcity of healthcare resources. Healthcare rationing has been a constant issue, but in the present pandemic, the need to choose who to treat and who to let die became a pressing reality. What criteria to adopt or what protocol to follow is a difficult challenge politicians face because it involves moral judgments and/or ethical values. As there are multiple ethically permissible criteria to allocate life-saving medical resources and we will all bear the consequences of these rationing decisions, it is important to explore the appropriateness of each of these approaches. Here, the author describes the main rationing criteria proposed in the literature and explores their applicability to an absolute scarcity of resources as the current one. Finally, the author describes the ongoing COVID-19 pandemic in Portugal and proposes some guidelines to ensure a fair allocation of resources.

Design/methodology/approach

A literature review was made regarding some rationing protocols, and a qualitative research was followed to collect data regarding the number of daily infected and daily deaths by COVID-19.

Findings

Portugal has not, fortunately and so far, been as badly hit by COVID-19 as other European Countries. However a rigorous and explicit protocol is lacking to help health professionals at the frontline to take legitimate rationing decisions.

Practical implications

The author contributes for the discussion about life-or-death decisions by proposing some clinical practice lines that may be applied fairly and consistently.

Originality/value

This study is the first attempt to emphasize the need to set life-or-death guidelines in Portugal in a public health emergency and to propose some of these guidelines.

Details

International Journal of Health Governance, vol. 26 no. 1
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 25 May 2021

Micaela Pinho

This paper aims to investigate the Portuguese general public views regarding the criteria that should guide critical COVID-19 patients to receive medical devices…

Abstract

Purpose

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”.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 35 no. 8
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 22 October 2018

Micaela Pinho and Ana Pinto Borges

The purpose of this study is to explore and compare citizens’ attitudes in Portugal, Bulgaria and Croatia towards rationing criteria that should support an explicit…

Abstract

Purpose

The purpose of this study is to explore and compare citizens’ attitudes in Portugal, Bulgaria and Croatia towards rationing criteria that should support an explicit priority setting process at the micro level.

Design/methodology/approach

Preferences were collected through an online questionnaire containing 14 statements concerning lottery, economic and person-based priority criteria. Respondents indicated their level of agreement with each criterion. Non-parametric tests were applied to compare the levels of agreement among 355, 298 and 243 Portuguese, Bulgarian and Croatian respondents, respectively.

Findings

The three groups of respondents appear to be concerned with both a fair and efficient allocation of resources. The severity of health conditions and patient’s age were the criteria most accepted by the respondents. This study suggests that Portuguese, Bulgarian and Croatian respondents have similar social values concerning patient prioritization, although the Portuguese adhere slightly more to efficiency criteria and less to person-based and lottery criteria than Bulgarian and Croatian respondents.

Practical implications

A majority of respondents across the three countries report having opinion about the bedside rationing criteria. Portuguese, Bulgarian and Croatian respondents accept a combination of personal and economic criteria in patient’s prioritization.

Originality/value

This study represents the first attempt to compare citizen’s opinions of three member states of the European Union.

Paper type

Research paper

Details

International Journal of Ethics and Systems, vol. 34 no. 4
Type: Research Article
ISSN: 0828-8666

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Article
Publication date: 25 July 2019

Micaela Pinho and Ana Pinto Borges

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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

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Article
Publication date: 1 December 2005

Ash Samanta and Jo Samanta

The purpose of this article is to provide a viewpoint on a controversial aspect of evidence‐based medicine (EBM) and its application to clinical decision making and…

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1394

Abstract

Purpose

The purpose of this article is to provide a viewpoint on a controversial aspect of evidence‐based medicine (EBM) and its application to clinical decision making and healthcare policy. To draw attention to the potential for using EBM as a rationalising tool, as opposed to rationalising treatment options, and to discuss how legitimacy in the decision‐making process may be secured.

Design/methodology/approach

A range of academic commentary and case law is reviewed. A model for the legitimacy of due process is suggested through the application of the framework for the “accountability for reasonableness”.

Findings

Provides information about sources indicating their relevance and where they can be found. Emphasises that NHS organisations and trusts need to enhance the legitimacy of due process through clinical governance.

Research limitations/implications

Presents a viewpoint designed to stimulate debate, which is based on a critical evaluation of the literature as well as contemporary quality initiative issues in the context of clinical governance.

Practical implications

A useful source of guidance for NHS Trust decision makers, healthcare practitioners and those involved with patient support initiatives.

Originality/value

This paper provides an original viewpoint on a topical and important issue and develops the concept of legitimacy and decision making that is delivered by the application of legal principles through clinical governance.

Details

Clinical Governance: An International Journal, vol. 10 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 14 May 2018

Hengameh Hosseini

The United States’ population is rapidly aging. As older people require more expensive medical and nursing attention, health-care/nursing costs keep rising, to the extent…

Abstract

Purpose

The United States’ population is rapidly aging. As older people require more expensive medical and nursing attention, health-care/nursing costs keep rising, to the extent that they are not sustainable. As a result, the USA is faced with an ethical dilemma. While egalitarian ethical principles and the provisions of the American Nurses Association (ANA) code of ethics require the provision of medical/nursing care to everyone regardless of age, severity of disease and productivity, utilitarians view that as impossible. Assuming that provisions ANA’s codes of ethics are the same as ethical principles, this paper aims to discuss the debate between those two sides in detail.

Design/methodology/approach

The paper, viewing the rise of health-care/nursing costs as the cause of the above ethical dilemma, discusses Daniel Callahan’s utilitarian argument that, given the ever-rising health/nursing costs as a percentage of GDP, the USA will be forced to ration health care/nursing on the basis of age. The ethical arguments opposing Callahan’s arguments will also be presented.

Findings

While the debate between those two viewpoints is bond to continue, some writers have tried to find a compromise, a solution by assuming that, through efficiency, health/nursing costs can be lowered, making Callahan’s age-based rationing unnecessary.

Originality/value

This paper is original as it, by including nursing costs as an inseparable component of health-care costs, makes the aforementioned debate applicable to nursing care.

Details

International Journal of Ethics and Systems, vol. 34 no. 2
Type: Research Article
ISSN: 0828-8666

Keywords

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