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The role of public values in setting health care priorities

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  • Hadorn, David C.

Abstract

Public values must play a substantial role in any attempt to deal with the health care resource allocation problem. This article examines how preferences for the health outcomes of care (e.g. improved or worsened physical suffering) can provide a coherent basis upon which set explicit health care priorities. Preferences for health outcomes could be mapped onto information concerning the outcomes expected from the specific health services when used for particular clinical conditions. These 'preference-weighted' outcomes would determine the relative priority given to health services for each specific condition. Generic outcome measures would be used in order to permit comparison of benefits and harms across different services. It is argued herein that allocation rules cannot be based on individual patients' preferences. Instead, average population preferences should be used to evaluate the relative importance of services--as occurs in other insurance contexts--despite theoretical concerns about the aggregation of preferences. Patients' preferences might also be estimated by reference to relevant demographic factors, but only if population subgroups are identified with relatively homogeneous preference patterns and if the use of such subgroups is deemed socially acceptable. Concerns about stereotyping and discrimination might limit the tractability of this approach.

Suggested Citation

  • Hadorn, David C., 1991. "The role of public values in setting health care priorities," Social Science & Medicine, Elsevier, vol. 32(7), pages 773-781, January.
    • Handle: RePEc:eee:socmed:v:32:y:1991:i:7:p:773-781
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    Cited by:

    1. Ogorevc, Marko & Murovec, Nika & Fernandez, Natacha Bolanos & Rupel, Valentina Prevolnik, 2019. "Questioning the differences between general public vs. patient based preferences towards EQ-5D-5L defined hypothetical health states," Health Policy, Elsevier, vol. 123(2), pages 166-172.
    2. Hagihara, Akihito & Murakami, Masayoshi & Miller, Alan S. & Nobutomo, Koichi, 1997. "Association between attitudes toward health promotion and opinions regarding organ transplants in Japan," Health Policy, Elsevier, vol. 42(2), pages 157-170, November.
    3. Paul Dolan, 1999. "Whose Preferences Count?," Medical Decision Making, , vol. 19(4), pages 482-486, October.
    4. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148, March.
    5. Menon, Devidas & Stafinski, Tania & Martin, Douglas, 2007. "Priority-setting for healthcare: Who, how, and is it fair?," Health Policy, Elsevier, vol. 84(2-3), pages 220-233, December.
    6. Brousselle, Astrid & Lessard, Chantale, 2011. "Economic evaluation to inform health care decision-making: Promise, pitfalls and a proposal for an alternative path," Social Science & Medicine, Elsevier, vol. 72(6), pages 832-839, March.
    7. Albert Weale, 2010. "Political Theory and Practical Public Reasoning," Political Studies, Political Studies Association, vol. 58(2), pages 266-281, March.
    8. Versteegh, M.M. & Brouwer, W.B.F., 2016. "Patient and general public preferences for health states: A call to reconsider current guidelines," Social Science & Medicine, Elsevier, vol. 165(C), pages 66-74.
    9. Sandoval, Guillermo A. & Barnsley, Jan & Berta, Whitney & Murray, Michael & Brown, Adalsteinn D., 2007. "Sustained public preferences on hospital performance across Canadian provinces," Health Policy, Elsevier, vol. 83(2-3), pages 246-256, October.
    10. G. Ardine De Wit & Jan J.V. Busschbach & Frank Th. De Charro, 2000. "Sensitivity and perspective in the valuation of health status: whose values count?," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 109-126, March.
    11. Peter A. Ubel & George Loewenstein, 1996. "Public Perceptions of the Importance of Prognosis in Allocating Transplantable Livers to Children," Medical Decision Making, , vol. 16(3), pages 234-241, August.
    12. Caroline M. Vass & Katherine Payne, 2017. "Using Discrete Choice Experiments to Inform the Benefit-Risk Assessment of Medicines: Are We Ready Yet?," PharmacoEconomics, Springer, vol. 35(9), pages 859-866, September.
    13. Ubel, Peter A. & Loewenstein, George, 1995. "The efficacy and equity of retransplantation: an experimental survey of public attitudes," Health Policy, Elsevier, vol. 34(2), pages 145-151, November.
    14. Peter C. Smith & Andrew Street, 2012. "Concepts and Challenges in Measuring the Performance of Health Care Organizations," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 32, Edward Elgar Publishing.
    15. Doherty, Jane E. & Rispel, Laetitia C., 1995. "From conflict to cohesion: Involving stakeholders in policy research," Evaluation and Program Planning, Elsevier, vol. 18(4), pages 409-415.
    16. Busschbach, Jan J. V. & McDonnell, Joseph & Essink-Bot, Marie-Louise & van Hout, Ben A., 1999. "Estimating parametric relationships between health description and health valuation with an application to the EuroQol EQ-5D," Journal of Health Economics, Elsevier, vol. 18(5), pages 551-570, October.
    17. Erik Nord, 1994. "The qaly—a measure of social value rather than individual utility?," Health Economics, John Wiley & Sons, Ltd., vol. 3(2), pages 89-93, March.
    18. Richardson, Jeff & McKie, John, 2005. "Empiricism, ethics and orthodox economic theory: what is the appropriate basis for decision-making in the health sector?," Social Science & Medicine, Elsevier, vol. 60(2), pages 265-275, January.
    19. World Bank, 2015. "Bulgaria Health Financing," World Bank Publications - Reports 22964, The World Bank Group.

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