Bedsides healthcare rationing dilemmas: A survey from Bulgaria and comparison with Portugal

Abstract

We 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.