The Views of Health Care Professionals and Laypersons Concerning the Relevance of Health-Related Behaviors in Prioritizing Patients.

This article aims to investigate to what extent health care professionals in Portugal find health-related behaviors relevant as a criterion to priority setting, to study what type of risk behavior they consider relevant in such decisions and to compare their views with those of laypersons. An online questionnaire was used to collect data from a sample of 178 health care professionals and 295 laypersons. The statistical analysis was performed through the application of generalized linear models and logistic regressions. Health professionals consider more than laypersons that information about health-related behaviors is relevant in prioritization between individuals. Both groups regard information about illegal drug abuse, excessive alcohol consumption, and smoking more important to priority setting decisions than information about overweight or lack of physical exercise. The findings are important for the definition of rationing policies as the professionals' decisions are those that, ultimately, influence health expenditure.

Economic decisions on who to treat when resources are not enough for everyone. Evidence from a Spanish survey / Decisiones económicas respecto a quién tratar cuando los recursos no son suficientes para todos. Evidencia de una encuesta española

ABSTRACT Objective To analyze the attitudes of Spanish citizens towards the criteria that should be used as a guide to make decisions regarding the prioritization of patients, namely, medical, economic and person-based criteria. Methods An online self-administered questionnaire was used to collect data from a sample of 546 Spanish respondents. The questionnaire was made up of three questions. In the first two questions respondents faced a hypothetical rationing dilemma involving four patients (differentiated by personal characteristics and health conditions) where they were asked to: (i) choose only one patient to be treated and (ii) rank the patients' assistance priority order. As for the third question, respondents were asked to state their level of agreement with 14 healthcare rationing criteria through a five-point Likert scale. Descriptive statistics, factor analysis and multinomial regressions were used. Results Findings suggest that Spanish respondents support a plurality of views on the rationing principles on which healthcare micro allocation decisions should be based. Despite the fact respondents support the idea that all patients should receive healthcare assistance equally, they also consider the age of the patient, as well as economic factors when establishing assistance priories among patients. Conclusions If it is not possible to provide health care assistance and treatments to all people, then age and economic factors should guide healthcare priority setting.(AU)

RESUMEN Objetivo Explorar las actitudes de los ciudadanos españoles hacia los principios que deben guiar las decisiones relativas a la priorización de pacientes. Métodos Se utilizó un cuestionario auto administrado en línea para recopilar datos de una muestra de 546 encuestados españoles. El cuestionario consta de tres preguntas. En las dos primeras preguntas, los encuestados se enfrentaron a un hipotético dilema de racionamiento con cuatro pacientes (diferenciados por características personales y condiciones de salud) donde tuvieron que: (i) seleccionar un solo paciente para tratar y (ii) clasificar a los pacientes por orden de asistencia. En la tercera pregunta, los encuestados tuvieron que indicar su nivel de acuerdo con 14 criterios de racionamiento a través de una escala de Likert de cinco puntos. Se usaron estadísticas descriptivas, análisis de factores y regresiones multinomiales. Resultados Los resultados sugieren que los encuestados españoles soportan una pluralidad de puntos de vista sobre los principios de racionamiento que sostengan las decisiones de micro asignación de los cuidados de salud. A pesar de que los encuesta-dos apoyan el valor ético de tratar a las personas por igual, también valoran la edad de los pacientes y los factores económicos al establecer las prioridades entre pacientes. Conclusiones Si las personas no pueden ser tratadas por igual, entonces la edad del paciente y las consideraciones económicas deben apoyar el establecimiento de prioridades de atención médica.(AU)

Economic decisions on who to treat when resources are not enough for everyone. Evidence from a Spanish survey.

OBJECTIVE: To analyze the attitudes of Spanish citizens towards the criteria that should be used as a guide to make decisions regarding the prioritization of patients, namely, medical, economic and person-based criteria. METHODS: An online self-administered questionnaire was used to collect data from a sample of 546 Spanish respondents. The questionnaire was made up of three questions. In the first two questions respondents faced a hypothetical rationing dilemma involving four patients (differentiated by personal characteristics and health conditions) where they were asked to: (i) choose only one patient to be treated and (ii) rank the patients' assistance priority order. As for the third question, respondents were asked to state their level of agreement with 14 healthcare rationing criteria through a five-point Likert scale. Descriptive statistics, factor analysis and multinomial regressions were used. RESULTS: Findings suggest that Spanish respondents support a plurality of views on the rationing principles on which healthcare micro allocation decisions should be based. Despite the fact respondents support the idea that all patients should receive healthcare assistance equally, they also consider the age of the patient, as well as economic factors when establishing assistance priories among patients. CONCLUSIONS: If it is not possible to provide health care assistance and treatments to all people, then age and economic factors should guide healthcare priority setting.

Relative Importance Assigned to Health Care Rationing Principles at the Bedside: Evidence From a Portuguese and Bulgarian Survey.

Activity was undertaken to develop a Prioritization Scoring Index for Portugal and Bulgaria that weights the importance given to ethical rationing principles that should guide decisions at the bedside. Data from two random samples of 355 Portuguese and 298 Bulgarian members of the public were collected from an online questionnaire. Questions asked about the level of importance given to specific issues related to patient's prioritization criteria. Responses were analyzed quantitatively with the SPSS. In the process of selecting the patient to treat, Portuguese and Bulgarian respondents seem unanimous in giving greater importance to (i) the treatment outcomes, (ii) the severity of illness, (iii) children, and (iv) patients' fragility. In general, Portuguese and Bulgarian respondents allocate more than 50% of the prioritization weight to equity considerations, approximately 35% to efficiency considerations, and 5% to lottery selection. Even so, Bulgarian respondents rate highly the equity and less the efficiency consideration than Portuguese respondents. Although the pursuit of efficiency seems to be valued by respondents, their major concern seems to be with the reduction of inequalities in health.