Patients' self-interested preferences: empirical evidence from a priority setting experiment

Area of Science:

• Health Economics
• Medical Decision Making
• Behavioral Economics

Background:

• Healthcare resource allocation involves complex priority setting.
• Understanding patient self-interest in surgical waiting list prioritization is crucial for equitable systems.

Purpose of the Study:

• To investigate whether patients prioritize hypothetical individuals on surgical waiting lists based on self-interest.
• To compare patient preferences with those of the general population in priority setting.

Main Methods:

• A ranking experiment was conducted in Galicia, Spain, involving patients awaiting prostatectomy and general population members.
• Rank-ordered logit analysis was applied to elicit preferences and develop a prioritization scoring system.
• A similarity-based procedure was implemented to assess self-interested rankings.

Main Results:

• Patient preferences for surgical waiting list prioritization significantly differ from general population preferences.
• Patients consider the similarity of hypothetical scenarios to their own condition when ranking, assigning higher priority to similar cases.
• This self-interest-driven prioritization increases the likelihood of respondents reporting "irrational" answers.

Conclusions:

• Patient self-interest demonstrably influences priority setting for elective surgical interventions.
• Healthcare priority setting models should account for patient-specific biases and self-interest.
• Findings highlight potential inequities in resource allocation driven by patient self-perception.