Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T04:09:53.013Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  10 June 2021

Micaela Pinho Open the ORCID record for Micaela Pinho [Opens in a new window]  and
Alexandra Araújo Open the ORCID record for Alexandra Araújo [Opens in a new window]
Micaela Pinho*
Affiliation:
University Portucalense, Research on Economics, Management and Information Technologies (REMIT) & Portucalense Institute for Legal Research (IJP), Porto, Portugal University Aveiro, Research Unit in Governance, Competitiveness and Public Policies (GOVCOPP), Aveiro, Portugal
Alexandra Araújo
Affiliation:
Portucalense Institute of Human Development (INPP), Porto, Portugal
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The scarcity of medical resources is widely recognized, and therefore priority setting is inevitable. This study examines whether Portuguese healthcare professionals (physicians vs nurses): (i) share the moral guidance proposed by ethicists and (ii) attitudes toward prioritization criteria vary among individual and professional characteristics. A sample of 254 healthcare professionals were confronted with hypothetical prioritization scenarios involving two patients distinguished by personal or health characteristics. Descriptive statistics and parametric analyses were performed to evaluate and compare the adherence of both groups of healthcare professionals regarding 10 rationing criteria: waiting time, treatment prognosis measured in life expectancy and quality of life, severity of health conditions measured in pain and immediate risk of dying, age discrimination measured in favoring the young over older and favoring the youngest over the young, merit evaluated positively or negatively, and parenthood. The findings show a slight adherence to the criteria. Waiting time and patient pain were the conditions considered fairer by respondents in contrast with the ethicists normative. Preferences for distributive justice vary by professional group and among participants with different political orientations, rationing experience, years of experience, and level of satisfaction with the NHS. Decision-makers should consider the opinion of ethicists, but also those of healthcare professionals to legitimize explicit guidelines.

Keywords

Distributional justicedistributive preferenceshealthcare professional attitudeshealthcare rationingmedical scarcityprioritizingsocialization theory
Type
Article
Information
Health Economics, Policy and Law , Volume 17 , Issue 4 , October 2022 , pp. 398 - 415
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aberese-Ako, M, Agyepong, I, Gerrits, T and Dijk, H (2015) I used to fight with them but now I have stopped!’: conflict and doctor-nurse-anaesthetists’ motivation in maternal and neonatal care provision in a specialist referral hospital. PLoS ONE 10, e0135129.CrossRefGoogle Scholar
Antiel, R, Curlin, F, James, K and Tilburt, J (2013) The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment. Philosophy, Ethics, and Humanities in Medicine 8, 13.CrossRefGoogle ScholarPubMed
Arvidsson, E, André, M, Borgquist, L, Andersson, D and Carlsson, P (2012) Setting priorities in primary health care – on whose conditions? A questionnaire study. BMC Family Practice 13, 114.CrossRefGoogle ScholarPubMed
Baggs, J (2005) Overview and summary: partnerships and collaboration: what skills are needed? The Online Journal of Issues in Nursing 10, 1, Overview and Summary.Google Scholar
Barra, M, Broqvist, M, Gustavsson, E, Henriksson, M, Juth, N, Sandman, L and Solberg, C (2020) Severity as a priority setting criterion: setting a challenging research agenda. Health Care Analysis 28, 25–44.CrossRefGoogle ScholarPubMed
Bauman, C and Skitka, L (2009) Moral disagreement and procedural justice: moral mandates as constraints to voice effects. Australian Journal of Psychology 61, 40–49.CrossRefGoogle Scholar
Beauchamp, T and Childress, J (2012) Principles of Biomedical Ethics. New York: Oxford University Press.Google Scholar
Beecroft, C (2016) Why health economics deserves a place in the medical curriculum. Journal of Comparative Effectiveness Research 5, 321–323.CrossRefGoogle ScholarPubMed
Bonča, P and Tajnikar, M (2008) Value added of health economics for health personnel. Medicinski Glasnik 5, 65–72.Google Scholar
Cappelen, A and Norheim, O (2005) Responsibility in healthcare: a liberal egalitarian approach. Journal of Medical Ethics 31, 476–480.CrossRefGoogle ScholarPubMed
Chan, E (2019) Political orientation and physical health: the role of personal responsibility. Personality and Individual Differences 141, 117–122.CrossRefGoogle Scholar
Cookson, R and Dolan, P (2000) Principles of justice in health care rationing. Journal Medical Ethics 26, 323–329.CrossRefGoogle ScholarPubMed
Cullati, S, Bochatay, N, Maître, F, Laroche, T, Muller-Judge, V, Blondon, K, Perron, N, Bajwa, N, Vu, N, Kim, S, Savoldelli, G, Hudelson, P, Chopard, P and Nendaz, M (2019) When team conflicts threaten quality of care: a study of health care professionals’ experiences and perceptions. Mayo Clinic Proceedings: Innovation, Quality & Outcomes 3, 43–51.Google ScholarPubMed
Da'ar, O and Al Shehri, A (2015) Towards integration of health economics into medical education and clinical practice in Saudi Arabia. Medical Teacher 37(Suppl. 1S), 56–60.CrossRefGoogle ScholarPubMed
Daniels, N (2008) Just Health: Meeting Health Needs Fairly. New York: Cambridge University Press.Google Scholar
Defaye, F, Desalegn, D, Danis, M, Hurst, S, Berhane, Y, Norheim, O and Miljeteig, I (2015) A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity,tough decisions and adverse consequences. BMC Health Services Research 15, 467.CrossRefGoogle ScholarPubMed
Dettmer, J (2020) Italians Demand Compensation for Coronavirus Deaths. Available at https://www.voanews.com/covid-19-pandemic/italians-demand-compensation-coronavirus-deaths [29 June 2020]Google Scholar
Deutsch, M (1975) Equity, equality, and need: what determines which value will be used as the basis of distributive justice? Journal of Social Issues 31, 137–149.CrossRefGoogle Scholar
Dolan, P, Cookson, R and Ferguson, B (1999) Effect of discussion and deliberation on the public’s views of priority setting inhealth care: focus group study. British Medical Journal 318, 916–919.CrossRefGoogle Scholar
Dolan, P, Shaw, R, Tsuchiya, A and Williams, A (2005) QALY Maximization and people's preferences: a methodological review of the literature. Health Economics 14, 197–208.CrossRefGoogle Scholar
European Economy (2014) The Economic Adjustment Programme for Portugal 2011‒2014. Occasional Papers 202. European Commission Directorate-General for Economic and Financial Affairs. Available at http://ec.europa.eu/economy_finance/publications/. [10 June 2020]Google Scholar
Fatoye, F (2013) Editorial: understanding of health economics among healthcare professionals. Journal of Clinical Nursing 22, 2979–2980.CrossRefGoogle ScholarPubMed
Gray, E and Lorgelly, P (2010) Health economics education in undergraduate medical degrees: an assessment of curricula content and student knowledge. Medical Teacher 32, 392–399.CrossRefGoogle ScholarPubMed
Gu, Y, Lancsar, E, Ghijben, P, Butler, J and Donaldson, C (2015) Attributes and weights in health care priority setting: a systematic review of what counts and to what extent. Social Science & Medicine 146, 41–52.CrossRefGoogle ScholarPubMed
Hadian, M, Jouyani, Y, Asadi, H, Palangi, H and Rahimnia, R (2019) Identifying the criteria affecting appropriate allocation of health system resources to different diseases in Iran: a qualitative inquiry. Health Scope 8, e83968.CrossRefGoogle Scholar
Hurst, S, Slowther, A, Forde, R, Pegoraro, R, Reither-Theil, S, Perrier, A, Garrett-Mayer, E and Danis, M (2006) Prevalence and determinants of physician bedside rationing: data from Europe. Journal of General Internal Medicine 21, 1138–1143.CrossRefGoogle ScholarPubMed
Hurst, S, Forde, R, Slowther, A and Danis, M (2014) The interaction of bedside rationing and the fairness of healthcare systems: Physicians views. In Danis, M, Hurst, S, Fleck, L, Ford, R and Slowther, R (eds), Fair Resource Allocation and Rationing at the Bedside, Part. one. Oxford: Oxford University Press.Google Scholar
Jain, V (2016) Time to take health economics seriously—medical education in the United Kingdom. Perspectives on Medical Education 5, 45–47.CrossRefGoogle ScholarPubMed
Johnson, R and Lord, R (2010) Implicit effects of justice on self-identity. Journal of Applied Psychology 95, 681.CrossRefGoogle ScholarPubMed
Kannan, V and Veazie, P (2018) Political orientation, political environment, and health behaviors in the United States. Preventive Medicine 114, 95–101.CrossRefGoogle ScholarPubMed
Kernick, D (2003) Introduction to health economics for the medical practitioner. Postgraduate Medical Journal 79, 147–150.CrossRefGoogle ScholarPubMed
Klein, R (1998) Managing scarcity: priority setting and rationing in the national health service. BMJ 314, 313.Google Scholar
Kreitner, R and Kinicki, A (2010) Organizational Behavior, 9th Edn. New York, NY: McGraw-Hill.Google Scholar
Krűtli, P, Rosemann, T, Tőrnblom, K and Smieszek, T (2016) How to fairly allocate scarce medical resources: ethical argumentation under scrutiny by health professionals and Lay. PLoS ONE 11, e0159086.CrossRefGoogle ScholarPubMed
Leavitt, K, Reynolds, S, Barnes, C, Schilpzand, P and Hannah, S (2012) Different hats, different obligations: plural occupational identities and situated moral judgments. Academy of Management Journal 55, 1316–1333.CrossRefGoogle Scholar
Lenton, A, Blair, I and Hastie, R (2006) The influence of social categories and patient responsibility on health care allocation decisions: bias or fairness? Basic and Applied Social Psychology 28, 27–36.CrossRefGoogle Scholar
Lian, O (2001) Norms for priority setting among health professionals: a view from Norway. Sociology of Health & Illness 23, 357–385.CrossRefGoogle Scholar
Lind, E, Kray, L and Thompson, L (1998) The social construction of injustice: fairness judgments in response to own and others’ unfair treatment by authorities. Organizational Behavior and Human Decision Processes 75, 1–22.CrossRefGoogle ScholarPubMed
Luyten, J, Kessels, R, Goos, P and Beutels, P (2015) Public preferences for prioritizing preventive and curative health care interventions: a discrete choice experiment. Value in Health 18, 224–233.CrossRefGoogle ScholarPubMed
Nord, E, Richardson, J, Street, A, Kuhse, H and Singer, P (1995) Maximizing health benefits vs egalitarianism: an Australian survey of health issues. Social Science and Medicine 41, 1429–1437.CrossRefGoogle ScholarPubMed
Olsen, J, Richardson, J, Dolan, P and Menzel, P (2003) The moral relevance of personal characteristics in setting health care priorities. Social Science & Medicine 57, 1163–1172.CrossRefGoogle ScholarPubMed
Papastavrou, E, Andreou, P and Efstathiou, G (2014) Rationing of nursing care and nurse–patient outcomes: a systematic review of quantitative studies. International Journal of Health Planning and Management 29, 3–25.Google ScholarPubMed
Persad, G, Wertheimer, A and Emanuel, E (2009) Principles for allocation of scarce medical interventions. Lancet 329, 224–227.Google Scholar
Pinho, M and Borges, A (2015) Bedside healthcare rationing dilemmas: a survey from Portugal. International Journal of Human Rights in Healthcare 8, 233–246.CrossRefGoogle Scholar
Pinho, M and Borges, A (2018) A three-country survey of public attitudes towards the use of rationing criteria to set healthcare priorities between patients. International Journal of Ethics and systems 34, 472–492.CrossRefGoogle Scholar
Pinho, M and Borges, A (2021) Healthcare professional's attitudes concerning prioritization decisions: a quali-quantitative analysis in Angola. Global Business and Economic Review 24(2), 128–146.CrossRefGoogle Scholar
Pinho, M and Costa, E (2020) Can mass media be an obstacle to rationing decisions? A case report from Portugal. International Journal of Health Governance 25, 3–11.CrossRefGoogle Scholar
Pinho, M and Veiga, P (2020) Attitudes of health professionals concerning bedside rationing criteria: a survey from Portugal. Health Economics, Policy and Law 15, 113–127.CrossRefGoogle ScholarPubMed
Pinho, M, Borges, A and Cookson, R (2018) Do healthcare professionals have different views about healthcare rationing than college students? A mixed methods study in Portugal. Public Health Ethics 11, 90–102.CrossRefGoogle Scholar
Rabin, M (1998) Psychology and economics. Journal of Economic Literature 36, 11–46.Google Scholar
Rhodes, A, Ferdinande, P, Flaatten, H, Guidet, B, Metnitz, P and Moreno, R (2012) The variability of critical care bed numbers in Europe. Intensive Care Medicine 38, 1647–1653.CrossRefGoogle ScholarPubMed
Rothstein, M (2010) Should health care providers get treatment priority in an influenza pandemic? The Journal of Law, Medicine and Ethics 38, 412–419.CrossRefGoogle Scholar
Sabik, L and Lie, R (2008) Priority setting in health care: lessons from the experiences of eight countries. International Journal for Equity in Health 7, 4.CrossRefGoogle ScholarPubMed
Siedlecki, S and Hixson, S (2015) Relationships between nurses and physicians matter. The Online Journal of Issues in Nursing 20, 6.Google ScholarPubMed
Strech, D, Synofzik, M and Marckmann, G (2008) How physicians allocate scarce resources at the bedside: a systematic review of qualitative studies. Journal of Medicine and Philosophy 33, 80–99.CrossRefGoogle ScholarPubMed
Subramanian, S, Huijts, T and Perkins, J (2009) Association between political ideology and health in Europe. Short report. European Journal of Public Health 19, 455–457.CrossRefGoogle Scholar
Sweeney, R and Watts, J (2009) Is there Value in Including Health Economics in an Undergraduate Medical Curriculum? Available at http://ihea2009.abstractbook.org/presentation/621/ [25 August 2020]Google Scholar
Tang, C, Chan, S, Zhou, W and Liaw, S (2013) Collaboration between hospital physicians and nurses: an integrated literature review. International Nursing Review 60, 291–302.CrossRefGoogle Scholar
Theofanidis, D (2015) A qualitative study on discrimination and ethical implications in stroke care in contemporary Greece. Journal of Vacular Nursing 33(4), 138–142.CrossRefGoogle ScholarPubMed
Törnblom, K (1992) The social psychology of distributive justice. In Scherer, KR (ed.), Justice: Interdisciplinary Perspectives. Cambridge: University Press, pp. 177–236Google Scholar
Tsuchiya, A, Dolan, P and Shaw, R (2003) Measuring peoples’ preferences regarding ageism in health: some methodological issues and some fresh evidence. Social Science and Medicine 57, 687–696.CrossRefGoogle Scholar
Tversky, A and Kahnneman, D (1981) The framing of decisions and the psychology of choice. Science 211, 453–458.CrossRefGoogle ScholarPubMed
Walster, E, Berscheid, E and Walster, G (1976) New directions in equity research. Advances in Experimental Social Psychology 9, 1–42.CrossRefGoogle Scholar
Walter, U (2012) Teaching health economics health care system and public health at German medical faculties. Gesundheitsw 74, 435–441.Google Scholar
Weinberger, S (2011) Providing high-value, cost-conscious care: a critical seventh general competency for physicians. Annals of Internal Medicine 155, 386–388.CrossRefGoogle ScholarPubMed
Werntoft, E and Edberg, AK (2009) The views of physicians and politicians concerning age-related prioritisation in healthcare. Journal of Health Organization and Management 23(1), 38–52.CrossRefGoogle ScholarPubMed
WHO (2019) Countries are spending more on health, but people are still paying too much out of their own pockets. Available at https://www.who.int/news-room/detail/20-02-2019-countries-are-spending-more-on-health-but-people-are-still-paying-too-much-out-of-their-own-pockets [5 June 2020]Google Scholar
Williams, A (1997) Intergenerational equity: an exploration of the ‘fair innings’ argument. Health Economics 6, 117–132.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Winkelhage, J and Diederich, A (2012) The relevance of personal characteristic in allocating health care resources – controversial preferences of laypersons with different educational backgrounds. International Journal of Environmental Research and Public Health 9, 223–243.CrossRefGoogle Scholar
Winkelhage, J, Schreier, M and Diederich, A (2013) Priority setting in health care: attitudes of physicians and patients. Health 5, 712–719.CrossRefGoogle Scholar
Wiseman, D (2006) Medical resource allocation as a function of selected patient characteristics. Journal of Applied Social Psychology 36, 683–689.CrossRefGoogle Scholar
Yun, L, Vanderloo, L, Berry, T, Latimer-Cheung, A, O'Reilly, N, Rhodes, R, Spence, J, Tremblay, M and Faulkner, G (2019) Political orientation and public attributions for the causes and solutions of physical inactivity in Canada: implications for policy support. Frontiers in Public Health 7, 153.CrossRefGoogle ScholarPubMed
Supplementary material: File

Pinho and Araújo supplementary material

Pinho and Araújo supplementary material

Download Pinho and Araújo supplementary material(File)
File 24.8 KB