Session 2.3 – Public Preferences and Values for Priority Setting
Wednesday October 29 15:30-17:00
Understanding Public Preferences for Health are Interventions: Does QALY Type Matter?
(Abstract 0061)Helen Mason, Rachel Baker, Cam Donaldson
Newcastle University, United Kingdom
The health care budget in the UK is finite therefore decisions must be made about which interventions to provide and which will not be provided. The aim of this study was to investigate the views of the general public about the types of interventions that should be funded and what characteristics of these interventions may be driving their choices. Some such characteristics of health care interventions that people have been shown to care about are: the effect they have on quality of life, length of life or a combination of quality and length of life as captured by QALYs. Alternatively it could be other things which relate to the interventions/illnesses in question. To try and get an understanding of this issue Q methodology was used with a sample of members of the general public. Q methodology is a method which is used to study peoples’ subjective opinions on a topic. Data are generated through a card-sorting exercise and analysed using factor analytic techniques. In this study respondents were asked to place a set of 36 cards, on which were printed descriptions of health care interventions covering a range of illness, onto a grid ranking them from those interventions they would give highest priority to through to those they would give lowest priority to if they could redistribute the health care budget. Factor analysis was then used to identify common patterns in respondents’ card sorts. Five factors or ‘points of view’ were identified from a sample of 52 people.
Involving the Public in Priority Setting: The use of Discrete Choice Experiments in NHS Dumfries & Galloway
(Abstract 0067)Verity Watson1, Andrew Carnon2, Mandy Ryan1, Derek Cox2
1Health Economics Research Unit, United Kingdom, 2NHS Dumfries & Galloway, United Kingdom
Background: Health organisations need to prioritise their use of resources. In addition, incorporating the views of the public into priority setting is important for accountability.
Objective: To develop and apply a new way of incorporating public views into priority setting using discrete choice experiments (DCE).
Methods: Ten criteria, based on Delivering for Health, were selected. These were: location of care, public consultation, use of technology, service availability, patient involvement, management of care, evidence of effectiveness, health gain, risk avoidance and priority area.
A random sample of 100 members of the public from Dumfries & Galloway was invited to participate in the DCE. They were presented with a series of choices between alternative care systems. These enabled trade-offs between the criteria to be inferred. Responses were analysed using multivariate regression. Benefit scores were calculated using the regression coefficients for new development bids from NHS Dumfries & Galloway.
Results: Seventy-two members of the public participated in the DCE event. All the criteria, except risk avoidance, were significant. The most important criteria were: a large health gain to many people; care being provided in teams; using cutting-edge technology; and 24 hour service availability. Local priorities were valued higher than national priorities.
Ninety-five bids were received from NHS Dumfries & Galloway. These were ranked in order of overall benefit score. This ranked list provided a useful tool to inform prioritisation decisions.
Policy Implications: The use of DCEs offers a theoretically valid and practical means of incorporating the public’s views in prioritisation decisions.
Stakeholder Preferences and Vertical Prioritization in the Treatment of Peripheral Arterial Disease
(Abstract 0094)Michael Freitag1, Birgitta Bayerl1, Kathrin Alber1, Eckhard Nagel1, Walter Wohlgemuth2
1University of Bayreuth, Germany, 2Klinikum Augsburg, Germany
Objective: To explore a broad set of preferred criteria for vertical prioritization in peripheral arterial disease for different stakeholders with special emphasis on evidenced-based medicine and health related quality of life.
Methods: A qualitative semi-structured interview questionnaire was developed and six stakeholder groups were interviewed during October 07 to April 08. The interview candidates differed systematically in the following characteristics:
- Physicians: general practitioners and specialists, both inpatient and outpatient sector (n=7)
- Nurses: level of experience, management level (n=3)
- Medical Review Board of the Statutory Sickness Funds: expert group (n=3)
- Patients: age, education, severity of illness (n=8)
- Relatives: age, education, severity of illness of the patient (n=9)
- Healthy people (people without a major disease): age, education (n=9)
39 interviews were conducted, transcribed and are analysed through a qualitative content analysis with MAXQDA 2007 using a categorization system allowing to explore and to weight the preferred criteria stated by interviewees.
Results: Especially patients and relatives deny the necessity of prioritization in the health care sector. The interview candidates express different preferences for prioritization criteria, differing more within than between stakeholder groups. Our study shows that evidenced based medicine and health related quality of life are not commonly accepted criteria in Germany.
Policy Implications: The description and analysis of specific stated stakeholder preferences may help to define criteria for priority setting in healthcare.
Priority Setting in Medicine – The German Debate
(Abstract 0138)Michael Freitag1, Kathrin Alber1, Birgitta Bayerl1, Walter Wohlgemuth2, Eckhard Nagel1
1University of Bayreuth, Germany, 2Klinikum Augsburg, Germany
After two decades of rationalization, the concepts of priority setting and rationing have become more visible in the German debate on resource allocation in health care.
Regulatory changes in the German health care system primarily addressed cost reduction and maintenance of insurance premiums. Given the ageing of the population paralleled by an increase of biomedical technology, the demand for medical care increases and the gap between the medically feasible and the financially affordable continues to widen.
Rationalization and further increases of financial contributions to the health care system have reached their limitations. A needful step is to encourage an explicit debate on priorities in health care provision which has not yet taken place in Germany.
Priorities should not solely rely on financial issues, but on medical, ethical and legal standards and preferences. The Ethics Commission of the German Medical Association issued statements on priority setting in 2000 and again in 2007. Formal (transparence, reasoning, evidence-base, consistency, legitimacy, declaration and balance of conflicts of interest, legal protection, regulation), and content-specific criteria (medical necessity, expected medical benefit, cost-effectiveness) are suggested and a hierarchical model is proposed with life support and therapy of severe pain ranked first and body enhancement and wellness ranked fourth.
In 2007, the interdisciplinary research group FOR655 on Priority Setting in Medical Care has been established by the German Research Foundation to empirically and theoretically explore the circumstances under which priority setting might help to allocate resources appropriately and to reduce disparities in health care.