Do Healthcare Professionals have Different Views about Healthcare Rationing than College Students? A Mixed Methods Study in Portugal

Pinho, Micaela; Borges, Ana Pinto; Cookson, Richard

doi:10.1093/phe/phx005

Cited by 7 publications

(17 citation statements)

References 50 publications

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“…those whose life or health may be at stake), and treatment outcome criterion were preferred in five out of six paired comparisons. This pattern of preferences corroborates the international evidence (Kapiriri and Norheim, 2004; Arvidsson et al , 2012; Hurst et al , 2014; Pinho et al , 2018). Of the remaining non-medical criteria, the PM was the most preferred criteria (in four of the six comparisons).…”

Section: Discussionsupporting

confidence: 86%

“…We suspect that respondents feel that to prioritize patients based on only two criteria is insufficient. This conclusion was found in recent studies that used a mixed methods approach to elicit both quantitative and qualitative responses (Pinho, 2016;Pinho et al, 2018). Physicians often used the lack of information about patients as an argument, when they did not want to make a choice between two patients (Pinho, 2016).…”

Section: Discussionmentioning

confidence: 84%

“…There is empirical literature on the views of health professionals in different countries concerning the rationing criteria that should guide patient prioritizations (Lees et al , 2002; Kapiriri and Norheim, 2004; Hurst et al , 2006; Lauridsen et al , 2008; Strech et al 2009; Arvidsson et al , 2012; Bahus et al , 2012; Antiel et al , 2013; Winkelhage et al , 2013; Hurst et al , 2014; Bahus and Førde, 2016; Pinho, 2016; Pinho et al , 2018). The conclusions seem to indicate that health professionals’ value judgments vary among countries and that they support multiple ethical criteria.…”

Section: Introductionmentioning

confidence: 99%

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Attitudes of health professionals concerning bedside rationing criteria: a survey from Portugal

Pinho

Veiga

2018

HEPL

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This paper tests the factorial structure of a questionnaire comprising seven health care rationing criteria (waiting time, ‘rule of rescue’, parenthood of minors, health maximization, youngest first, positive and negative version of social merit) and explores the adherence to them of 254 Portuguese health care professionals, when considered individually and when confronted with two-in-two combinations. Data were collected through a self-administered questionnaire where respondents faced hypothetical rationing dilemmas comprising one rationing criterion and dichotomous options pairs with two rationing criteria. Confirmatory factor analysis and multinomial logistic regressions were used to validate the structure of the questionnaire and the data. The findings suggest that: (i) the hepta-factorial structure of the questionnaire presented a good fit of the data; and (ii) support for rationing criterion depends on whether they are individually considered or confronted in dichotomous options pairs. When only one criterion distinguishes the patients, healthcare professionals support six criteria (by descending order): waiting time, rule of rescue, health maximization, penalization of patients’ risky behaviors, youngest first and being parent of a young child. When two criteria were confronted, immediate threat of life/health and large expected benefits were the most preferred. Conversely, the positive version of social merit was an unappreciated rationing criterion.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Attitudes of health professionals concerning bedside rationing criteria: a survey from Portugal

Pinho

Veiga

2018

HEPL

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“…Considering the report published by OECD concerning wasteful spending on health (OECD, 2017), Portugal did not present a good performance and some improvements can be achieved with health professionals' collaboration, for example, reducing unnecessary interventions and hospital-acquired infections. Previous literature also showed that doctors should have the greatest influence in deciding how NHS money is spent (Lees et al , 2002) and also that doctors should be the main agents for prioritisation decisions (Botelho et al , 2013), or health professionals, in general (Pinho et al , 2018; Pinho and Borges, 2015).…”

Section: Resultsmentioning

confidence: 99%

Managing NHS money in Portugal: who decides?

Reis¹,

Borges²,

Araújo

2020

IJHG

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PurposeThe need to reduce health expenditures raises the discussion on rationing possibilities and there is a growing interest in considering society's perspectives. The aim of this paper was to evaluate Portuguese citizens' opinion regarding the imposition of limits on National Health Service (NHS) spending. We also asked who decides how NHS money is spent, in order to obtain the respondents' views on public involvement.Design/methodology/approachAn online questionnaire was used to collect data. Descriptive and inferential statistics, factorial analysis and a logit model were applied.FindingsOur results showed that most of the respondents believe citizens have low participation on NHS' financial decisions, confirming the lack of public involvement. Health professionals are more likely to agree with limits on NHS spending, which could indicate potential inefficiencies.Practical implicationsFrom a health policy perspective, we have concluded that different stakeholders should be involved before deciding how public spending limits should be implemented. Health professionals' perspectives should be considered, taking advantage of their experience.Originality/valueThe main novelty of this paper is the evaluation of whether there should be limits on NHS spending, comparing health professionals and non-health professionals.

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“…Others support giving preferential treatment to those who are signi cantly ill or vulnerable, (6) and others believe that younger patients and those with fewer risks of complication should be given priority. (10) Students nd it morally distressing to think that one day it may be their responsibility to decide who gets access to critical healthcare and who will likely die without it, as a result of some public health emergency-related hospital policy that overrides their clinical judgment. A er all, they all went into medicine to help people and save lives, not to use arti cial intelligence-derived prognostic algorithms or play God and let people die.…”

mentioning

confidence: 99%

COVID-19 impact on medical education and the future post-pandemic era for medical students

Ross¹,

Kumar²,

Dillon³

et al. 2020

The British Student Doctor Journal

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The COVID-19 global emergency has brought about unexpected changes in the format and quality of undergraduate medical education in a short period of time. The impact of remote delivery on medical students learning, satisfaction, con dence, social relationships, communications and emotional wellbeing has been signi cant. The lack of direct patient and teacher contact is generating anxiety about their future competence. The ambivalence about the urge to help without su cient clinical skills and the fear of being either infected or becoming an asymptomatic carrier that puts patient safety at risk is of concern to them. We o er suggestions for enhancing pandemic or global emergency preparedness for the future. Strategies to manage the way in which remote learning is delivered need to be implemented as a matter of urgency if social distancing and quarantine regulations keep medical students away from hands-on clinical practice for long periods. Actions to maintain motivation and trust in the medical schools to meet their learning needs now and in the future are warranted.

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Do Healthcare Professionals have Different Views about Healthcare Rationing than College Students? A Mixed Methods Study in Portugal

Cited by 7 publications

References 50 publications

Attitudes of health professionals concerning bedside rationing criteria: a survey from Portugal

Attitudes of health professionals concerning bedside rationing criteria: a survey from Portugal

Managing NHS money in Portugal: who decides?

COVID-19 impact on medical education and the future post-pandemic era for medical students

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