Equity Weights for Priority Setting in Healthcare: Severity, Age, or Both?

Area of Science:

• Health economics
• Public health policy
• Decision science

Background:

• Healthcare priority setting often balances efficiency and equity.
• Equity considerations commonly use disease severity (e.g., absolute or proportional shortfall).
• Existing severity metrics may overlook age, a crucial factor in health equity.

Purpose of the Study:

• To investigate societal preferences for disease severity versus patient age in healthcare allocation.
• To compare the relative importance of severity and age in public decision-making.

Main Methods:

• Utilized choice tasks and person-trade-off tasks with a representative Dutch sample (N=1025).
• Elicited preferences where severity and age varied separately and simultaneously.
• Employed regression models to analyze trade-off ratios.

Main Results:

• Societal preferences favored younger patients and higher severity when considered separately.
• When assessed simultaneously, younger age received higher preference weights, overriding severity.
• Preference weights increased with larger differences in severity and age.

Conclusions:

• Severity-based healthcare allocation models may not align with public preferences.
• Decision-making frameworks should incorporate age-related societal preferences for improved equity.
• Age is a significant, independently weighted factor in public healthcare prioritization.