What does your study focus on?

Van Exel: “Last March, we saw a huge increase in the number of Covid infections and hospital admissions. This gave rise to a public debate about what we should do if we started exceeding hospital capacity. What if despite the lockdown, our healthcare sector was overwhelmed by the virus – resulting in a shortage of IC beds. At that point, we would have to decide who is and isn’t admitted to the IC ward. Our study examines the Dutch public’s views on this decision process. Who should be taking these decisions, and which criteria should be referred to in this context?

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What motivated you to research this subject precisely?

Dieteren: “I think a desire to gain insight into how things work, as well as people’s thought processes. Apart from this, research into healthcare and its economics is always incredibly interesting, since basically, the sector is faced with continuous scarcity – forcing practitioners to more or less constantly prioritise. The Covid crisis offers us a kind of field experiment that we prefer to have done without. But suddenly we do have these new opportunities to research interesting relationships, which otherwise wouldn’t have been outlined so starkly.”

Van Exel: “I am specifically interested in choices made within the healthcare sector. How can we improve this process so that the sector works better for everyone? Deciding who is given a bed in the IC ward is a horrible dilemma for physicians, and a kind of taboo for policymakers in our society. This makes it all the more interesting to me – to understand how different groups handle this situation. In a crisis like this, it’s important to create broad support regarding its handling. And for the people ultimately responsible for taking these decisions, it is also reassuring to know they’re endorsed by the general public.”

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And, which view does the general public take? Who should be given an IC bed, and who decides on the matter?

Van Exel: “The key finding is that in principle, everyone should have the same chance of being admitted to the IC ward. In addition, there is a strong feeling that high-risk groups – i.e. people who are more at risk due to their occupation, or patients who are extra vulnerable – should be given preferential treatment. But on the other hand, we can also see a preference for patients with the best prospects of a full recovery.”

Dieteren: “The one message that shines through when you look at most answers to the open questions is that more than anything, a lot of people find it a very difficult decision to make – and are happy they don’t have to bear this responsibility. Another thing we see, for example, is that people are happy to leave this decision to the treating physicians and hospital management.”

Van Exel: “And perhaps the most remarkable finding of all: a lot of people believe we should simply scale up the number of beds in the IC ward, since we shouldn’t actually have this kind of scarcity in a highly developed country like the Netherlands.”

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Which important developments have you observed in healthcare and the sector’s decision-making processes as a consequence of the pandemic?

Van Exel: “Due to the huge influx of Covid-19 patients, a share of regular care has been cancelled or postponed. And measures like these are not without consequences. However, it’s difficult to determine whether the health wins you make and fatalities you can avoid by focusing on Covid-19 outweigh the health losses and extra deaths caused by postponing and cancelling other care.”

Dieteren: “At the start of the pandemic, they developed a protocol for hospitals, code black. This would be implemented if we exceeded capacity – leading to shortages. Fortunately, things never got that bad, but age was one of the criteria for selection. It’s interesting to now compare this protocol to the results of this study, since they actually show that the public doesn’t subscribe to age as a decisive factor.”

Which challenges have you personally run into in your work due to the pandemic?

Dieteren: “For me, one of the big attractions of performing scientific research is the scope it offers for creativity. Working from home, you no longer have spontaneous talks with colleagues around the coffee maker, in a corridor or at a get-together. I think encounters like these have sparked quite a few interesting new research ideas, and now we have to work without these opportunities.”

Van Exel: “I really miss personal interaction with colleagues and students. I find online teaching both challenging and far less fulfilling. Online meetings are less effective and cost a lot more energy – particularly with larger groups and when the discussion isn’t running very smoothly. All in all, I think I enjoy my work less than I used to, and it remains difficult to find the right work-life balance. On the other hand, this crisis has put a spotlight on the relationship between health and economics, which is precisely our field of expertise. This means that everything you do can count on more attention than usual.”