Search results

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 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.

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

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

Research paper

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.

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.

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.

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

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.

The World Health Organisation recognises that health and well-being are essential to achieve the United Nations Development Agenda 2030. Non-communicable diseases (NCDs) are the leading causes of ill-health worldwide. Much of the global burden of NCD is caused by individual unhealthy behaviours. A behavioural mindset shift is needed to reduce premature NCD mortality. This article provides an exploratory analysis to understand whether Portuguese society is on the path to achieving better health by considering certain unacceptable individual lifestyles that contribute to diseases and could be avoided.

An online questionnaire was used to collect data from 558 Portuguese citizens. Descriptive statistics and non-parametric tests were used to (1) assess whether respondents were aware of premature mortality caused by NCDs, (2) explore whether individuals should be accountable for their disease-related behaviours, and (3) test for associations between this accountability and respondents sociodemographic and health characteristics.

Overall, respondents were unaware of the rate of premature mortality associated with chronic diseases and were unwilling to hold fellow citizens accountable for their unhealthy lifestyles. Following a healthy lifestyle proved relevant in the moralisation of others' unhealthy lifestyles, especially those who practice physical exercise.

This study is the first attempt to awaken attention to the impact that societies' procrastination for others' harmful health behaviours may have on achieving Sustainable Development GoalS (SDGs) and sustainable development.

Healthcare professionals are key in healthcare organisations but are subject to long working hours and may have to make complex life-and-death decisions. As frontline agents dealing with human lives, giving them a voice is paramount. This study explores the impact of employee voice (assessed based on employee perceptions on how much they are consulted and how much influence they have on task-related decisions) on health professionals' work engagement and burnout when mediated by relational outcomes (perceived organisational support, workplace trust, workplace recognition and meaningful work).

A sample of 3,266 health professionals retrieved from the European Working Condition Survey was used. The quantitative analysis was performed using the partial least square structural equation modelling and multiple regression analyses.

The results indicate that employee voice has a direct positive impact on work engagement, but employee voice's direct effects on burnout still need to be confirmed. Relational outcomes are found to mediate the relationship between employee voice and burnout (decreasing it) and between employee voice and work engagement (increasing it).

Practices of employee voice in the workplace are fundamental to promoting health professionals' well-being. Trust, recognition, support and the feeling of doing meaningful work increase the influence of employee voice, especially in reducing the levels of burnout.

This is the first study that assesses, at a European level, the importance that ‘giving health professionals a voice' has on crucial employee outcomes: work engagement, burnout and relational outcomes.