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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

Keywords

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.

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

Keywords

Article
Publication date: 6 August 2021

Micaela Pinho and Ana Moura

The purpose of this study is to provide a decision support tool to deal with the problem of seting priorites among patients competing for limited health care resources…

Abstract

Purpose

The purpose of this study is to provide a decision support tool to deal with the problem of seting priorites among patients competing for limited health care resources. Limited resources and unlimited demands prevent health-care services to be provided to all those in need. This became publicity evident with the current Covid-19 pandemic. Although controversial, health care rationing has always existed and is now inevitable. Setting priorities becomes then inevitable. How to define those priorities is a complex and yet irresolvable issue mainly because it involves several and conflicting criteria, translated into efficiency and equity considerations. This is why multi-criteria decision analysis (MCDA) was introduced to health care as an appropriate decision-support framework for solving complex problems.

Design/methodology/approach

This paper proposes the application of two combined approaches – analytic hierarchy process (AHP)-Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) and AHP-VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR), as decision support tools to rank patients with competing needs in a more effective and equitable way. A rationing scenario involving four patients, differentiated by personal characteristics and health conditions, is used to illustrate, test and compare the applicability of both approaches. After extraction of the relative weights of the prioritization criteria involved in the hypothetical scenario from paired wise comparison methods, TOPSIS and VIKOR priority setting methods were designed.

Findings

Results suggest that patients ranking from both combination approaches are similar and in accordance with the order made directly by health-care professionals. Therefore, the relative weights computed by AHP in combination with TOPSIS and/or VIKOR methods could be used with suitable applicability by health-care decision-makers.

Originality/value

This study is the first attempt to apply a combination of MCDA methods to patients’ prioritization context and the first to cross previous studies to deepen and consolidate the research.

Details

Journal of Science and Technology Policy Management, vol. 13 no. 3
Type: Research Article
ISSN: 2053-4620

Keywords

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…

199

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

Keywords

Article
Publication date: 8 October 2019

Micaela Pinho and Jorge Marques

The purpose of this paper is to explore the potentialities and weaknesses of the city of Porto (Portugal) in the business tourism segment in order to ensure and develop a…

Abstract

Purpose

The purpose of this paper is to explore the potentialities and weaknesses of the city of Porto (Portugal) in the business tourism segment in order to ensure and develop a destination’s business tourism strategy position.

Design/methodology/approach

Data were collected through the participation of 28 experts living/working in Porto in a three-round Delphi exercise. Experts should identify the main straights, weaknesses and opportunities of the city for the business tourism development.

Findings

The main results show that the city’s potential to become landmark destination in the business tourism sector far outweighs its limitations. With measures aimed to improve the functionality of the business tourism segment and marketing strategies to increase external promotion, Porto meets the conditions to become an excellent business tourism destination.

Originality/value

Many studies have been conducted from the perspective of leisure tourism; few have been conducted from the perspective of the business tourism and none have been conducted from the perspective of the business tourism in the city of Porto. This research fills a gap in the literature relating to the practice of meeting industry. It represents the first attempt to elicit stakeholders opinions about important issues related to the development of business tourism in the city. The results of the study provide a more informed and systematic basis on which to develop the business tourism segment in Porto.

Details

International Journal of Tourism Cities, vol. 7 no. 1
Type: Research Article
ISSN: 2056-5607

Keywords

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

Article
Publication date: 24 March 2022

Micaela Pinho, Natércia Durão and Boyan Zahariev

The problematic surrounding patients' prioritization decisions are currently at the centre of political leaders' concerns. How to define whom to treat when there are not…

Abstract

Purpose

The problematic surrounding patients' prioritization decisions are currently at the centre of political leaders' concerns. How to define whom to treat when there are not enough resources to treat everybody is the key question. This exploratory study aims to investigate the views of Bulgarian citizens regarding the relevance of the information concerning eight individual health-related behaviours in priority setting decisions: smoking, excess of alcohol, illegal drug use, overweight/obesity, speed driving, extreme sports practice, unsafe sex and overuse of internet and/or mobile devices.

Design/methodology/approach

Data were collected through a questionnaire where 322 respondents faced hypothetical rationing dilemmas comprising option pairs of the eight risky behaviours. Descriptive statistics and non-parametric tests were performed to define the penalization of each of the risky behaviours and to test for the association between this penalization and the respondent's health habits and sociodemographic characteristics.

Findings

Most respondents would refuse to grant access to healthcare based on patients' personal responsibility for the disease. Nevertheless, respondents were more willing to consider illegal drug use, excessive alcohol consumption, engagement in unsafe sex behaviours and smoking. Respondent's own interest or advantage seems to be somehow relevant in explaining the penalization of risk behaviours in priority setting.

Practical implications

This study shows that most respondents support the lottery criterion and thus do not want to see lifestyle prioritization in action.

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 in Bulgaria.

Details

International Journal of Health Governance, vol. 27 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

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

Article
Publication date: 11 May 2020

Micaela Pinho

This study aims to explore the views of pharmacy professionals (PPs) in Portugal about generic medicines and international non-proprietary name (INN) prescribing and…

Abstract

Purpose

This study aims to explore the views of pharmacy professionals (PPs) in Portugal about generic medicines and international non-proprietary name (INN) prescribing and compare them with the views of general practitioners (GPs).

Design/methodology/approach

A self-administered questionnaire was used to collect data from a sample of 185 community PPs and 85 GPs. Their perceptions were examined using a five-point Likert scale applied to statements focusing on five main topics of interest: motivation, safety, users’ perceptions and knowledge, advantages and disadvantages of generic medicines and INN prescribing. Daily experiences and suggestions for decreasing health and pharmaceutical expenses were explored through open-ended questions. Nonparametric tests were used to compare attitudes between both groups and to explore associations between the level of agreement and respondents’ demographic characteristics. Content analysis was used to categorize the answers to the open-ended questions.

Findings

Generally, GPs expressed more negative opinions toward generics and INN prescribing than PPs. GPs perceived generics as less effective, less safe, inferior in quality, more likely to cause side effects and believed that users do not trust them. Both groups believed that patients remain very confused and ill-informed about generics, only adhering to them because of their low cost and expressed concerns about the existence of an excessive number of generic medicines and the lack of patients’ responsibility toward medicines costs.

Originality/value

To the best of the authors’ knowledge, this study represents the first attempt to elicit and compare Portuguese GPs and PPs opinions concerning INN prescribing.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 14 no. 2
Type: Research Article
ISSN: 1750-6123

Keywords

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