Pinho, Micaela
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Pinho
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Micaela
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Micaela Pinho
Biography
Micaela Pinho é doutorada em Economia pela Escola de Economia e Gestão da Universidade do Minho. É Professora Associada na Universidade Portucalense e Professora Convidada na Universidade de Aveiro. Leciona unidades curriculares de Microeconomia e Macroeconomia. A sua principal área de investigação é Economia da Saúde. Tem inúmeros livros publicados de microeconomia, macroeconomia, estatística a economia industrial. Tem inúmeros artigos científicos publicados nas áreas da Economia da Saúde, sustentabilidade e turismo.
Afiliação:
REMIT – Research on Economics, Management and Information Technologies.
DEG - Departamento de Economia e Gestão.
AF14-3E2F-3400
23990998900
L-1789-2018Research Projects
Organizational Units
REMIT – Research on Economics, Management and Information Technologies
Centro de investigação que que tem como objetivo principal produzir e disseminar conhecimento teórico e aplicado que possibilite uma maior compreensão das dinâmicas e tendências económicas, empresariais, territoriais e tecnológicas do mundo contemporâneo e dos seus efeitos socioeconómicos. O REMIT adota uma perspetiva multidisciplinar que integra vários domínios científicos: Economia e Gestão; Ciências e Tecnologia; Turismo, Património e Cultura.
Founded in 2017, REMIT – Research on Economics, Management and Information Technologies is a research unit of Portucalense University. Based on a multidisciplinary and interdisciplinary perspective it aims at responding to social challenges through a holistic approach involving a wide range of scientific fields such as Economics, Management, Science, Technology, Tourism, Heritage and Culture.
Grounded on the production of advanced scientific knowledge, REMIT has a special focus on its application to the resolution of real issues and challenges, having as strategic orientations:
- the understanding of local, national and international environment;
- the development of activities oriented to professional practice, namely in the business world.
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Publication Open Access Social and ethical criteria for prioritizing patients: A survey of students and health professionals in Portugal.2016 - Pinho, MicaelaThis qualitative/quantitative study examines the ethical dilemma of microallocation of health resources. It seeks to identify and compare the opinion of two groups in Portuguese society – students and health professionals – on the importance of personal characteristics of patients at the moment of prioritizing them and if the choices can be explained by bioethical references of a utilitarian or deontological nature. Data were collected by means of a questionnaire administered to a sample of 180 students and 60 health professionals. Faced with hypothetical emergency scenarios, the respondents had to choose between two patients (distinguished by: age, gender, social responsibility, economic and employment situation, harmful health behaviors and criminal record), duly selecting who to treat and then justifying their choice. The results suggest the existence of differences in choices between the two groups, with health professionals revealing they are less prepared to accept the use of social criteria in a context of scarce resources and co-existence of utilitarian and deontological criteria, with a predominance of efficiency on the part of health professionals and equity on the part of students.Publication Open Access Fórum: Racionamento dos Cuidados de Saúde: Introdução2008 - Pinho, MicaelaExplicit rationing of health care is one of the most important issues under debate in the academic and political fields in both developed and developing countries. The articles presented in this Forum provide an approach to some of the questions relating to this issue. The approach is multidisciplinary, covering complex ethical questions and the contribution of economics to the debate. The analyses reveal specificities associated with the shift from implicit approach for rationing of health care, traditionally dominant in health systems, to a systematic and explicit priority-setting method in general and the potential incompatibility between efficiency and equity objectives in health policy in particular. The Forum's reflections link directly to current worldwide discussions on the questions “Why ration health care?” and “How to ration health care?”.Publication Open Access Avaliação de custo-utilidade como mecanismo de alocação de recursos em saúde: Revisão do debate2009 - Veiga, Paula Alexandra Correia Veloso; Pinho, MicaelaPriorty setting in health care involves choosing between alternative health care programs and/or patients or groups of patients who will receive care. Tradicionally, health economists have prposed maximizing the additional health gain measured in QALYs as a way of setting priorities and maximizing social welfare. This requires that social value from health improvements be a product of gains in years of life, quality of life,and number of people treated. The results of a literature review suggest that potential health gain is not a single relevant determinant of value, nor is the role of maximizing this gain sufficient. The social value of a health gain appears not to be linear in termsof mortality and morbidity, or neutral vis-à-vis people’s characteristics or the ultimate distribution of health in society. In parallel with the review of the debate on the role and limitation of QALYs for prioritizing health care resources, the article attempts to justify the controversy over some empirical results, particularly in relation to the construction and expression of social preferences.Publication Restricted Access Bedsides healthcare rationing dilemmas: A survey from Bulgaria and comparison with Portugal2017 - Borges, Ana Pinto; Zahariev, Boyan; Pinho, MicaelaWe investigate the views of Bulgarian citizens on the principles that should guide microallocation healthcare resources and compare them directly with those of Portuguese citizens. A self-administered online questionnaire was used to collect data from a sample of 298 Bulgarian citizens, using methods from a matching previous study in Portugal. Respondents faced a hypothetical rationing exercise where they had to choose and order four patients (differentiated by personal and health characteristics) and a set of statements that embodied: (i) distributive criteria for prioritizing patients, (ii) who should prioritize patients, and (iii) the likelihood of these prioritization decisions being real. Descriptive statistics, factor analysis, and non-parametric test were used. Findings suggest that Bulgarian respondents: (i) support a plurality of distributive principles to underpin healthcare priority setting with an incident on the severity of health conditions, on utilitarianism and on reducing health inequalities; (ii) trust in the health professional to make prioritization decisions and (iii) do not seem to believe that patients' prioritization will ever become real. While Bulgarian and Portuguese respondents support a number of shared ethical principles they place a different level of importance to each. Bulgarians value mainly the age criterion in prioritizing patients, whereas Portuguese revealed a greater concern about efficiency.Publication Restricted Access Can mass media be an obstacle to rationing decisions? A case report from Portugal2020-02 - Costa, Eva Dias; Pinho, MicaelaPurpose Continuous introduction of advanced health technologies coupled with limited resources force governments to adopt rationing measures in all types of health systems. The mass media can influence the application of these measures by rising people and patients' expectations and demands for new forms of healing. This article intends to find evidence of this influence by reporting two recent cases which occurred in Portugal involving two innovative drugs, one for the treatment of hepatitis C and another for type I spinal muscular atrophy. The new drugs were not publicly funded despite promising excellent overall health outcomes because of their high cost and exaggerated burden on national health system (NHS). Design/methodology/approach A qualitative research was used to collect information conveyed by the conventional media and social networks. Findings After a strong dissemination through conventional and social media of the nonapproved treatments, the drugs swiftly garnered support among the public and triggered remarkable and relentless advocacy efforts. The findings of this paper suggest that society opinions and, by extension, the decision of policy-makers are very susceptible to the influence of the mass media. Practical implications New ways of sharing information are changing health research and public health. Social implications These stories raise complex tensions and important questions about resource-allocation decisions involving scientific research or innovative medicine. Societal preferences seem very vulnerable to information conveyed by the mass media. Originality/value This study is the first attempt to awaken attention to the influence that Portuguese mass media may exercise on future healthcare rationing decisions.Publication Open Access Comparing professional and non professionals views about equity efficiency tradeoffs in healthcare rationing.2016 - Pinho, MicaelaIntroduction: In a context of scarcity, prioritizing patients is plagued with dificulties concerning eficiency-equity trade-offs. According to cost effectiveness analysis, the aim of a public health is to maximize the production of health. However, it has been increasingly obvious that social values, rather than being linear in potential health gains, seem to be increasing with the fair distribution of health care resources. Objectives: This study attempts to compare the opinion of two groups of the Portuguese society, people in general and health professionals, about: 1) eficiency-equity trade-offs related to intervention’s effect on patients’ health; 2) public involvement in health care rationing decisions. Methods: Quantitative methods were applied to data collected from a random sample of 180 college students and 60 health professionals. A questionnaire was developed with four hypothetical rationing exercises. In each scenario, due to scarcity of resources, respondents must decide which patient to choose. The exercises comprise tradeoffs between lengths of life and (i) quality of life; (ii) rule of rescue; (iii) cost of the treatment and (iv) rule of rescue and quality of life. Results: Findings suggest the existence of signiicant differences in the choices made by both groups. Health professionals seem to: 1) value more the length of life than the quality of life or the rule of rescue principle; 2) agree less with the direct involvement of the public in rationing decisions. Conclusions: Results suggest that healthcare professionals seem to be more in accordance with the eficiency principle while students seem to be more concerned with equity considerations.Publication Open Access Do healthcare professionals have different views about healthcare rationing than college students? A mixed methods study in Portugal2017-05 - Borges, Ana Pinto; Cookson, Richard; Pinho, MicaelaThe main aim of this paper is to investigate the views of healthcare professionals in Portugal about healthcare rationing, and compare them with the views of college students. A self-administered questionnaire was used to collect data from a sample of 60 healthcare professionals and 180 college students. Respondents faced a hypothetical rationing dilemma where they had to order four patients (differentiated by personal characteristics and health conditions) and justify their choices. Multinomial logistic regressions were used to test for differences in orderings, and content analysis to categorize the written justifications. The findings suggest that both groups appeared to support three main rationing principles: (i) health maximization, (ii) priority to the severely ill and (iii) priority to the young. However, professionals seemed to give less weight to the latter principle. In conclusion, professionals have similar views to students about healthcare rationing, though may be slightly less inclined to give priority to the young.Publication Restricted Access The views of health care professionals and laypersons concerning the relevance of health-related behaviors in prioritizing patients2019-06-17 - Borges, Ana Pinto; Pinho, MicaelaThis 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.Publication Open Access Fórum: Racionamento dos cuidados de saúde: Problemática inerente2008 - Pinho, MicaelaLimited resources in the health sector force a process of choice between alternative health care programs and services and patients or groups of patients who will receive care. In the absence of a price mechanism, the priority-setting process serves to allocate scarce resources among competing uses, and is thus a form of rationing. Traditionally, implicit approaches have dominated the health sector’s decision-making, mostly by physicians. However, in the face of increasing budget constraints and rising patient expectations, more explicit and socially acceptable priority- setting practices are needed. Internationally, the development of explicit prioritization has proven difficult and controversial.Publication Open Access The dilemma of managing scarce health care resources: Evidence of the conflict between economic or ethical principles in microallocation decisions2014 - Pinho, MicaelaHealth economists proposed maximizing additional health gains as a criterion to set priorities and to maximize social welfare in the microallocation of healthcare resources. This requires that social values from health improvements are neutral in relation to personal characteristics of people, which seems to be often contradicted by empirical evidence. This paper addresses the social and ethical values that can potentially conflict with economic ones in decisions taken at the micro level of healthcare rationing. Using quantitative and qualitative data collected from a random sample of 200 college students we explore their (i) orientations and motivations when faced with hypothetical scenarios involving prioritization of patients that are distinguished only by their personal characteristics and (ii) views concerning its involvement in decision making over which patients to treat. Findings suggest: (i) the coexistence of fairness and economic orientations among respondents even though utilitarianism received the greatest support; (ii) that although respondents wish to be consulted in matters of microallocation decisions, they do not want to assume the role of deciding between patients.