Moral Values, Perceived Access to Care and Preferences for Healthcare Resource Allocation

Background: The National Health Service (NHS) is under financial pressure, and the allocation of healthcare resources relies on complex decision-making processes. Rationality is key in rationing procedures, yet its definition is subjective. Additionally, ethical frameworks associated with rationing processes may be ill-equipped to address health-related social injustices. Literature suggests emotions, intuition, rationality, moral values, and narratives of deservedness may infiltrate preferences about healthcare resources allocation (PHRA).
Aims: This research explored how factors drawn from the literature (demographic characteristics, moral judgement, health locus of control, political views, and perceived access to health resources) are associated with PHRA.
Methods: A pragmatic stance with a cross-sectional quantitative approach was adopted. PHRA was defined by author-designed health vignettes with four ethical
response options. These were presented to 549 adults in an online survey alongside standardised questionnaires.
Results: Chi-Square analyses suggested that demographic characteristics (e.g. ethnicity and job types) were associated with PHRA in some vignettes but not others. Kruskal Wallis and post hoc tests found differences in PHRA based on political views, moral values, and internal health locus of control. Deprioritising certain groups or allocation based on previous taxation contribution was associated with high internal health locus of control, right-wing views, and moral concerns associated with this stance. Left-wing participants with a lower internal locus of control and moral concerns about care were represented more often in the group that favoured the vulnerability-based options. Specific results differed significantly for each vignette.
Conclusion: The situation-specific nature of the results suggests that participants were not relying on single ethical frameworks when allocating resources and that PHRA may be associated with intuitive processes. Thereafter, the ‘Intuition & Bias Accountability Framework’ is proposed so that healthcare services are held accountable for bias, and practical rationality is acknowledged as a positive tool for social justice.