A three-country survey of public attitudes towards the use of rationing criteria to set healthcare priorities between patients

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

Attitudes towards priority setting in the Norwegian health care system: a general population survey

“…There is a rich literature on stakeholders’ views regarding priority setting in health care. In Europe, several surveys have been conducted on how stakeholders view different criteria for priority setting [ 18 – 27 ]. Some use traditional questionnaires [ 18 – 21 , 24 , 27 ], while others apply discrete choice experiments (including vignettes) [ 22 – 25 ].…”

“…In Europe, several surveys have been conducted on how stakeholders view different criteria for priority setting [ 18 – 27 ]. Some use traditional questionnaires [ 18 – 21 , 24 , 27 ], while others apply discrete choice experiments (including vignettes) [ 22 – 25 ]. A handful of surveys have also explored the same question using qualitative methods [ 26 , 29 – 31 ].…”

How to fairly allocate scarce medical resources? Controversial preferences of healthcare professionals with different personal characteristics

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“…We believe that physicians are generally better equipped to estimate a patient's imminence in risk of death, given a particular health condition, which may explain this discrepancy between both groups of healthcare practitioners. Having a low valorization of the patient's risk of death may raise concerns since there's some empirical evidence suggesting that Portuguese lay people (Pinho and Borges, 2015) as well as the general population in other countries (Dolan et al ., 2005; Krűtli et al ., 2016; Gu et al ., 2015; Pinho and Borges, 2018), health professionals (Lian, 2001; Arvidsson et al ., 2012; Krűtli et al, 2016; Pinho and Borges, 2021) and even experts in healthcare systems (Hadian et al ., 2019) feel the obligation to save, in the first place, those patients in emergency and life-threatening conditions.…”

“Live and Let Die”: What We Learned From US Healthcare and What Seems to Be Valid in the COVID-19 Pandemic

“…Non-maleficence : When US President Trump visited that mask factory in Arizona, “Live and Let Die,” which many found cynical in view of the simultaneous situation in many US states, can also be seen as a metaphor for a current medical–ethical question. For years, in almost all countries of the world, medical ethics has been discussing the questions of rationing and prioritization in the face of scarcity of funds in the healthcare system ( 18 ).…”