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

Published online by Cambridge University Press:  15 October 2018

Micaela Pinho*
Affiliation:
Universidade Portucalense, Research on Economics, Management and Information Technologies – REMIT, DEG, Oporto, Portugal University of Aveiro, Research Unit in Governance, Competitiveness and Public Policies, DEGEIT, Aveiro, Portugal
Pedro Veiga
Affiliation:
Research Unit in Business Sciences – NECE, University of Beira Interior, Covilhã, Portugal
*
*Corresponding author. Email: [email protected]

Abstract

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.

Type
Articles
Copyright
© Cambridge University Press 2018 

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References

Abelson, JGauvin, F‐P (2006) Assessing the Impacts of Public Participation: Concepts, Evidence and Policy Implications. Research Report P06 Ontario: Canadian Policy Research Networks. http://www.cprn.org/documents/42669_fr.pdf [21 January 2017].Google Scholar
Antiel, R, Curlin, F, James, KTilburt, 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.Google Scholar
Arvidsson, E, André, M, Borgquist, L, Andersson, DCarlsson, P (2012) Setting priorities in primary health care – on whose conditions? A questionnaire study. BMC Family Practice 13, 114.Google Scholar
Bahus, MFørde, R (2016) Discussing end-of-life decisions in a clinical ethics committee: an interview study of Norwegian doctors’ experience. HEC Forum, 28(3): 261272.Google Scholar
Bahus, M, Steen, PFørde, R (2012) Law, ethics and clinical judgment in end-of-life decisions – How do Norwegian doctor’s thing?. Resuscitation 83, 13691373.Google Scholar
Beauchamp, TChildress, J (2012) Principles of Biomedical Ethics New York: Oxford University Press.Google Scholar
Botelho, A, Pinho, MVeiga, P (2014) Who should participate in health care priority setting and how should priorities be set? Evidence from a Portuguese survey. Revista Portuguesa de Saúde Pública 31(12): 214222.Google Scholar
Bowling, A (1996) Health care rationing: the public debate. British Medical Journal 312, 670674.Google Scholar
Brock, D (2002) ‘Fairness and health’, in C. Murray (ed.) Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications. Geneva, Switzerland: World Health Organization, 717726.Google Scholar
Brockmann (2002) Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals. Social Science & Medicine 55(4): 593608.Google Scholar
Callahan D (1985) What do children owe elderly parents? The Hastings Center Report, 15(2): 3237.Google Scholar
Callahan D (1987) Setting Limits: Medical Goals in an Aging Society. New York: Simon and Schuster.Google Scholar
Cappelen, ANorheim, O (2005) Responsibility in healthcare: a liberal egalitarian approach. Journal of Medical Ethics 31(8): 476480.Google Scholar
Clark, SWeale, A (2012) Social values in health priority setting: a conceptual framework. Journal of Health Organization and Management 26, 293316.Google Scholar
Coast, J (2001) Citizens, their agents and health care rationing: an exploratory study using qualitative methods. Health Economy 10, 159174.Google Scholar
Cookson, RDolan, P (2000) Principles of justice in health care rationing. Journal of Medical Ethics 26, 323329.Google Scholar
Daniels, N (1985) Just Healthcare. Cambridge: Harvard University Press.Google Scholar
Daniels, NSabin, J (1997) Limits to health care: fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philosophy and Public Affairs 26(4): 303350.Google Scholar
Delden, J, Vrakking, A, Van der Heide, A Van der Maas, P (2004) Medical decison making in scarcity situations. Journal of Medical Ethics 30, 207211.Google Scholar
Dolan, P, Cookson, RFerguson, B (1999) Effect of discussion and deliberation on the public’s views of priority setting in health care: focus group study. British Medical Journal 318, 916919.Google Scholar
Dolan, PShaw, R (2003) A note on the relative importance that people attach to different factors when setting priorities in health care. Health Expectations 6(1): 5359.Google Scholar
Eurostat (2017) Statistics Explained. Health in the European Union – facts and figures. European Commission. http://ec.europa.eu/eurostat/statisticsexplained/index.php/Unmet_health_care_needs_statistics [4 January 2017].Google Scholar
Gu, Y, Lancsar, E, Ghijben, P, Butler, JDonaldson, C (2015) Attributes and weights in health care priority setting: a systematic review of what counts and to what extent. Social Science & Medicine 146, 4152.Google Scholar
Hair, J, Ringle, CSarstedt, M (2011) PLS-SEM: indeed a silver bullet. Journal of Marketing Theory and Practice 19, 139152.Google Scholar
Hair, J, Sarstedt, M, Hopkins, LKuppelwieser, V (2014) Partial least squares structural equation modeling (PLS-SEM): an emerging tool in business research. European Business Review 26(2): 106121.Google Scholar
Halvorsen, K, Slettebø, A, Nortvedt, P, Pedersen, R, Kirkevold, M, Nordhaug, MBrinchmann, S (2008) Priority dilemmas in dialysis: the impact of old age. Journal of Medicine Ethics 34, 585589.Google Scholar
Harris, J (1985) The Value of Life. London: Routledge & Kegan Paul.Google Scholar
Hurst, S, Forde, R, Slowther, ADanis, M (2014) ‘The interaction of bedside rationing and the fairness of healthcare systems: physicians views’, in M Danis et al. (eds), Fair Resources Allocation and Rationing at the Bedside. Oxford: Oxford University Press.Google Scholar
Hurst, S, Slowther, A-M, Forde, R, Pegoraro, R, Reiter-Theil, S, Perrier, A, Garrett-Mayer, EDanis, M (2006) Prevalence and determinants of physician bedside rationing data from Europe. Journal of General Internal Medicine 21(11): 11381143.Google Scholar
Kapiriri, LNorheim, O (2004) Criteria for priority-setting in health care in Uganda: exploration of stakeholders’ values. Bulletin of the World Health Organization 82(3): 172179.Google Scholar
Kasemsup, V, Schommer, J, Cline, RHadsall, R (2008) Citizen’s preferences regarding principles to guide health care allocation decisions in Thailand. Value in Health 11(7): 11941202.Google Scholar
Keeney, R (1996) Value Focused Thinking: A Path to Creative Decision Making. Cambridge: Harvard University Press.Google Scholar
Krütli, P, Rosemann, T, Törnblom, KSmieszek, T (2016) How to fairly allocate scarce medical resources: ethical argumentation under scrutiny by health professionals and lay people. PLoS One 11(7): e0159086.Google Scholar
Johri, M, Damschroder, L, Zikmund-Fisher, BUbel, P (2005) The importance of age in allocating health care resources: Does intervention‐type matter? Health Economics 14(7): 669678.Google Scholar
Jonsen, A (1986) Bentham in a box: technology assessment and health care allocation. Law, Medicine & Health Care 14(3-4): 172174.Google Scholar
Lauridsen, S, Norup, MRossel, P (2008) Bedside rationing by general practitioners: a postal survey in the Danish public healthcare system. BMC Health Services Research 8, 192201.Google Scholar
Lees, A, Scott, N, Scott, S, MacDonald, SCampbell, C (2002) Deciding how NHS money is spent: a survey of general public and medical views. Health Expectations 5(1): 4754.Google Scholar
Litva, A, Coast, J, Donovan, J, Eyles, J, Shepherd, M, Tacchi, J, Abelson, JMorgan, K (2002) The public is too subjective: public involvement at different levels of health-care decision-making. Social Science & Medicine 4(12): 18251837.Google Scholar
Luyten, K, Kessels, R, Goos, PBeutels, P (2015) Public preferences for prioritizing preventive and curative health care interventions: a discrete choice experiment. Value in Health 18(2): 224233.Google Scholar
McKie, R, Shrimpton, B, Hurworth, R, Bell, CRichardson, J (2008) Who should be involved in health care decision making? A qualitative study. Health Care Analysis 16(2): 114126.Google Scholar
Myllykangas, M, Ryynanen, O, Lammintakanen, J, Isomaki, V, Kinnunen, JHalonen, P (2003) Clinical Management and prioritization criteria. Finnish experiences. Journal of Health Organization and Management 17(5): 338348.Google Scholar
OECD/EU (2016) Health at a Glance: Europe 2016 – State of Health in the EU Cycle Paris: OECD Publishing. http://dx.doi.org/10.1787/9789264265592-enGoogle Scholar
Persad, G, Wertheimer, AEmanuel, E (2009) Principles for allocation of scarce medical interventions. Lancet 329, 224227.Google Scholar
Pinho, M (2016) Social and ethical criteria for prioritizing patients: a survey of students and health professionals in Portugal. Ciência & Saúde Coletiva 21(12): 39173926.Google Scholar
Pinho, M, Borges, ACookson, R (2018) Do health professionals have different views about healthcare rationing than college students? A mixed methods study in Portugal. Public Health Ethics 11(1): 90102.Google Scholar
Rabin, M (1998) Psychology and economics. Journal of Economic Literature 36(1): 1146.Google Scholar
Ramsey, P (2002) The Patient as Person: Exploration in Medical Ethics. New Haven, CT: Yale University Press.Google Scholar
Rawls, J (1972) A Theory of Justice. Oxford: Oxford University Press.Google Scholar
Ringle, CM, Wende, SBecker, J-M (2015) SmartPLS 3. SmartPLS GmbH: Boenningstedt. http://www.smartpls.com. [4 February 2017].Google Scholar
Sabin, J (2000) ‘Fairness as a problem of love and the heart: a clinician’s perspective on priority setting’, in C. Ham and H. Coulter (eds), The Global Challenge of Health Care Rationing. Buckingham: Open University Press, 117122.Google Scholar
Scheunemann, L, Douglas, BWhite, M (2011) The ethics and reality of rationing in medicine. Chest 140(6): 16251632.Google Scholar
Shah, K (2009) Severity of illness and priority setting in healthcare: a review of the literature. Health Policy 93(2-3): 7784.Google Scholar
Stakellarides, C, Castelo-Branco, L, Barbosa, PAzevedo, H (2014) The impact of the financial crisis on the health system and health in Portugal. European Observatory of Health Systems and Policies. World Health Organization. http://www.euro.who.int/__data/assets/pdf_file/0006/266388/The-impact-of-the-financial-crisis-on-the-health-system-and-health-in-Portugal.pdf?ua=1 [15 January 2017].Google Scholar
Strech, D, Persad, G, Marckmann, GDanis, M (2009) Are physicians willing to ration health care? Conflicting findings in a systematic review of survey research. Health Policy 90(2-3): 113124.Google Scholar
Theodorou, M, Samara, K, Pavlakis, A, Middleton, N, Polyzos, NManiadakis, N (2010) The public’s and doctor’s perceived role in participation in setting healthcare priorities in Greece. Health Journal of Cardiology 51, 200208.Google Scholar
Tsuchiya, A, Dolan, PShaw, R (2003) Measuring people’s preferences regarding ageism in health: some methodological issues and some fresh evidence. Social Science & Medicine 57, 687696.Google Scholar
Tversky, AKahneman, D (1974) Judgment under uncertainty: heuristics and biases. Science, New Series 185(4157): 11241131.Google Scholar
Werntoft, EEdberg, A-K (2009) The views of physicians and politics concerning age-related prioritization in healthcare. Journal of Health Organization and Management 23(1): 3852.Google Scholar
Williams, ACookson, R (2000) ‘Equity in health’, in A Culyer and P Newhouse (eds), Handbook of Health Economics, Amsterdam, North-Holland: Elsevier Science, 1863–1907.Google Scholar
Winkelhage, J, Schreier, MDiederich, A (2013) Priority setting in health care: attitudes of physicians and patients. Health 5, 712719.Google Scholar
Zweibel, N, Cassel, CKarrison, T (1993) Public attitudes about the use of chronological age as a criterion for allocating health care resources. The Cerontologist 33(1): 7480.Google Scholar
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