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Is There a General Preference for the Worse Off? A Discrete Choice Experiment Using Individually Calibrated Health
Marius L Torjusen1, Kim Rand2, David Gt Whitehurst3
1The Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Summary
This study explored public healthcare priority setting preferences using individual health state values. Results indicate a preference for prioritizing the better off, not the worse off, challenging common healthcare policy assumptions.
Area of Science:
- Health Economics
- Public Health Policy
- Decision Science
Background:
- Healthcare priority setting often involves complex ethical considerations.
- Public preferences are crucial for policy legitimacy but are challenging to measure accurately.
- Existing studies may lack individual-level health state valuations, potentially biasing results.
Purpose of the Study:
- To develop and demonstrate a method for assessing public healthcare priority setting preferences.
- To examine Norwegian population preferences for prioritizing the 'worse off' versus health maximization.
- To investigate the impact of individual-level health state values on preference elicitation.
Main Methods:
- Face-to-face interviews with 468 Norwegian adults.
- Valuation of EQ-5D-5L health states using time trade-off.
- Discrete choice tasks comparing utility maximization and benefit to the worse off.
Main Results:
- Respondents' choices were influenced by health improvement size, not solely by pre-treatment health state.
- Demographic factors (gender, religion, age) affected choice behavior.
- On average, preferences leaned towards prioritizing the better off.
Conclusions:
- The developed two-stage method using individual health state values is feasible for preference research.
- No evidence was found supporting a public preference for prioritizing the worse off when using individual valuations.
- Findings suggest a need to reconsider assumptions in healthcare priority setting frameworks.
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