Toward future triage regulations: Investigating preferred allocation principles of the German public

Philipp Sprengholz; Lisa Felgendreff; Alena Buyx; Cornelia Betsch

doi:10.1016/j.healthpol.2023.104845

Toward future triage regulations: Investigating preferred allocation principles of the German public

Health Policy. 2023 Aug:134:104845. doi: 10.1016/j.healthpol.2023.104845. Epub 2023 Jun 7.

Authors

Philipp Sprengholz¹, Lisa Felgendreff², Alena Buyx³, Cornelia Betsch²

Affiliations

¹ Institute of Psychology, University of Bamberg, Bamberg, Germany; Health Communication, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany. Electronic address: philipp.sprengholz@uni-bamberg.de.
² Health Communication, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany.
³ Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany.

PMID: 37307760
DOI: 10.1016/j.healthpol.2023.104845

Abstract

Background: When intensive care capacity is limited, triage may be required. Given that the German government started working on new triage legislation in 2022, the present study investigated the German public's preferences for intensive care allocation in two situations: ex-ante triage (where multiple patients compete for available resources) and ex-post triage (where admitting a new patient to intensive care means withdrawing treatment from another because ICU resources are depleted).

Method: In an online experiment, N=994 participants were presented with four fictitious patients who differed in age and pre- and post-treatment chance of survival. In a series of pairwise comparisons, participants were asked to select one patient for treatment or to opt for random selection. Ex-ante and ex-post triage situations were varied between participants and preferred allocation strategies were inferred from their decisions.

Results: On average, participants prioritized better post-treatment prognosis ahead of younger age or treatment benefit. Many participants rejected random allocation (on the flip of a coin) or prioritization by worse pre-treatment prognosis. Preferences were similar for ex-ante and ex-post situations.

Discussion: Although there may be good reasons for deviating from laypeople's preference for utilitarian allocation, the results can help to design future triage policies and accompanying communication strategies.

Keywords: Intensive Care; Public Health Ethics; Resource Allocation; Triage.

MeSH terms

Hospitalization*
Humans
Resource Allocation
Triage*