Aggregating public preferences for healthcare: putting theory into practice

The aim of this study was to investigate alternative methods for aggregating public preferences that may then be used to guide priority-setting decisions in healthcare. This involved asking members of the Australian public to assume the role of a healthcare planner and to allocate an additional (but fixed) amount of healthcare resources across three sets of options: medical/surgical procedures, public health programmes and across population groups exhibiting different characteristics. Two methods of aggregation were used: rank ordering and what the author describes as the 'pie method'. In contrast to conventional social welfare functions (that make use of ordinal, non-comparable utility information of individual consumers), the methods used in this study allowed for additional information on the intensity and the comparability of the preferences. The impact of these different methods on aggregation results is investigated. It is argued that those decision makers charged with the day-to-day responsibility of engaging the general public in resource allocation decision making need to be aware that different methods of aggregation can result in different healthcare priorities. Implications for researchers, including the impact of different forms of information on the formation of social preferences, are also discussed.