Investigating public preferences on 'severity of health' as a relevant condition for setting healthcare priorities

This study examines the preferences of a sample of the UK general public over the allocation of healthcare resources. Preferences were elicited against scenarios where alternative patient groups are competing for limited resources. Respondents were asked to make a choice between either (i) groups described according to alternative descriptions for severity of health condition, or (ii) groups described according to a broader level of disadvantage (e.g. family income). The survey used a random-location quota sampling approach, and face-to-face interview techniques. Interviews were completed with 261 people in the Southampton area of England. Results showed that the majority or respondents wanted to divide resources equally between competing groups, giving at least equal preference to the more severely affected group, and the more disadvantaged group, regardless of a stated lower potential health gain in these groups compared to alternatives. In the severity of health question 60% indicated that a unit of health gain in a severely affected patient group was of greater social value to that same unit of health gain in a moderately affected patient group, all else equal. When described by level of disadvantage, 80% of respondents stated such a preference, which indicates that they attach a greater social value to a unit of health gain in a disadvantaged patient group, compared to a more advantaged group, all else equal. When given an option to 'opt out' of a difficult decision, and to 'let others choose', very few respondents (5%) took that option, suggesting that the most common stated preference of dividing resource equally between groups may be a true preference, rather than respondents avoiding difficult decisions. When interpreting the findings from the survey, results suggest that preferences reported to give priority to those more severely affected by their health, may also be a reflection of a broader preference to treat those groups classed as worse-off, in empirical studies. Results are discussed against the growing importance of the empirical ethics literature, and the growing needs of health policy makers to seek out an empirical basis upon which to consider the challenges of setting priorities in healthcare.