Reeskens Tim, Roosma Femke, Wanders Evelien
School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
BMC Public Health. 2021 Mar 5;21(1):447. doi: 10.1186/s12889-021-10488-3.
Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access.
Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking.
The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts.
People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.
在新冠疫情期间,政府、健康专家和伦理学家针对重症监护病房(ICU)分诊以及优先接种疫苗提出了指导方针。为提高政治合法性和问责制,公众支持至关重要。本研究探讨了除医疗需求之外,哪些标准对于被视为优先获得新冠医疗服务而言被认为是重要的。
在荷兰具有代表性的1461名受访者的概率样本中,开展了两项关于ICU治疗优先权和新冠疫苗早期接种的联合实验。受访者被问及在两名虚构的医疗服务申请者中,谁应接受治疗,这两名申请者在年龄、体重、遵守新冠政策措施和职业方面存在差异,所有这些都是随机分配的。估计平均边际系数效应以评估各属性的相对重要性;各属性与相关受访者特征进行交互,以确定在这种相对排名中是否存在共识。
荷兰人惩罚那些不遵守新冠政策措施的人和肥胖者,但优先考虑在“关键”部门工作的人。对于这些情况,民众中存在共识。对于年龄,年轻人在ICU治疗中被优先考虑,而中年人在疫苗接种方面被优先考虑,年轻受访者更倾向于为老年申请者提供医疗服务,而年长受访者则更倾向于支持年轻群体。
那些无法控制自身社会风险但能够回馈社会的人被认为更应优先获得新冠医疗服务。我们的研究结果为已实施的关于ICU治疗和新冠疫苗的伦理指导方针提供了合理支持。