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Priority setting in the German healthcare system: results from a discrete choice experiment

Author

Listed:
  • V. Meusel

    (FAU Erlangen-Nürnberg)

  • E. Mentzakis

    (City University of London)

  • P. Baji

    (Corvinus University of Budapest)

  • G. Fiorentini

    (University of Bologna)

  • F. Paolucci

    (Murdoch University
    University of Bologna)

Abstract

Worldwide, social healthcare systems must face the challenges of a growing scarcity of resources and of its inevitable distributional effects. Explicit criteria are needed to define the boundaries of public reimbursement decisions. As Germany stands at the beginning of such a discussion, more formalised priority setting procedures seem in order. Recent research identified multi-criteria decision analysis (MCDA) as a promising approach to inform and to guide decision-making in healthcare systems. In that regard, this paper aims to analyse the relative weight assigned to various criteria in setting priority interventions in Germany. A discrete choice experiment (DCE) was employed in 2015 to elicit equity and efficiency preferences of 263 decision makers, through six attributes. The experiment allowed us to rate different policy interventions based on their features in a composite league table (CLT). As number of potential beneficiaries, severity of disease, individual health benefits and cost-effectiveness are the most relevant criteria for German decision makers within the sample population, the results display an overall higher preference towards efficiency criteria. Specific high priority interventions are mental disorders and cardiovascular diseases.

Suggested Citation

  • V. Meusel & E. Mentzakis & P. Baji & G. Fiorentini & F. Paolucci, 2023. "Priority setting in the German healthcare system: results from a discrete choice experiment," International Journal of Health Economics and Management, Springer, vol. 23(3), pages 411-431, September.
  • Handle: RePEc:kap:ijhcfe:v:23:y:2023:i:3:d:10.1007_s10754-023-09347-y
    DOI: 10.1007/s10754-023-09347-y
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    References listed on IDEAS

    as
    1. Anthony J. Culyer, 2006. "The bogus conflict between efficiency and vertical equity," Health Economics, John Wiley & Sons, Ltd., vol. 15(11), pages 1155-1158, November.
    2. Emily Lancsar & Jordan Louviere, 2008. "Conducting Discrete Choice Experiments to Inform Healthcare Decision Making," PharmacoEconomics, Springer, vol. 26(8), pages 661-677, August.
    3. Razavi, S. Donya & Kapiriri, Lydia & Wilson, Michael & Abelson, Julia, 2020. "Applying priority-setting frameworks: A review of public and vulnerable populations’ participation in health-system priority setting," Health Policy, Elsevier, vol. 124(2), pages 133-142.
    4. Esther W. de Bekker‐Grob & Mandy Ryan & Karen Gerard, 2012. "Discrete choice experiments in health economics: a review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 145-172, February.
    5. Anthony J Culyer, 2015. "Efficiency, equity and equality in health and health care," Working Papers 120cherp, Centre for Health Economics, University of York.
    6. Sauerland, Dirk, 2001. "The German strategy for quality improvement in health care: still to improve," Health Policy, Elsevier, vol. 56(2), pages 127-147, May.
    7. David Hensher & William Greene, 2003. "The Mixed Logit model: The state of practice," Transportation, Springer, vol. 30(2), pages 133-176, May.
    8. Baltussen, Rob & Youngkong, Sitapon & Paolucci, Francesco & Niessen, Louis, 2010. "Multi-criteria decision analysis to prioritize health interventions: Capitalizing on first experiences," Health Policy, Elsevier, vol. 96(3), pages 262-264, August.
    9. David Revelt & Kenneth Train, 1998. "Mixed Logit With Repeated Choices: Households' Choices Of Appliance Efficiency Level," The Review of Economics and Statistics, MIT Press, vol. 80(4), pages 647-657, November.
    10. Arne Risa Hole, 2007. "Fitting mixed logit models by using maximum simulated likelihood," Stata Journal, StataCorp LP, vol. 7(3), pages 388-401, September.
    11. Madeleine T. King & Jane Hall & Emily Lancsar & Denzil Fiebig & Ishrat Hossain & Jordan Louviere & Helen K. Reddel & Christine R. Jenkins, 2007. "Patient preferences for managing asthma: results from a discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 16(7), pages 703-717, July.
    12. Colin Green & Karen Gerard, 2009. "Exploring the social value of health‐care interventions: a stated preference discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 951-976, August.
    13. Lancsar, Emily & Louviere, Jordan & Flynn, Terry, 2007. "Several methods to investigate relative attribute impact in stated preference experiments," Social Science & Medicine, Elsevier, vol. 64(8), pages 1738-1753, April.
    14. Thijs Schoot & Milena Pavlova & Elka Atanasova & Wim Groot, 2017. "Preferences of Bulgarian consumers for quality, access and price attributes of healthcare services—result of a discrete choice experiment," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(1), pages 47-71, January.
    15. Adele Diederich & Joffre Swait & Norman Wirsik, 2012. "Citizen Participation in Patient Prioritization Policy Decisions: An Empirical and Experimental Study on Patients' Characteristics," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-10, May.
    16. Adele Diederich & Jeannette Winkelhage & Norman Wirsik, 2011. "Age as a Criterion for Setting Priorities in Health Care? A Survey of the German Public View," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-10, August.
    17. Emmanouil Mentzakis & Mandy Ryan & Paul McNamee, 2011. "Using discrete choice experiments to value informal care tasks: exploring preference heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 930-944, August.
    18. Mandy Ryan & Karen Gerard & Gillian Currie, 2012. "Using Discrete Choice Experiments in Health Economics," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 41, Edward Elgar Publishing.
    19. Kjaer, Trine & Gyrd-Hansen, Dorte, 2008. "Preference heterogeneity and choice of cardiac rehabilitation program: Results from a discrete choice experiment," Health Policy, Elsevier, vol. 85(1), pages 124-132, January.
    20. Ottersen, Trygve & Førde, Reidun & Kakad, Meetali & Kjellevold, Alice & Melberg, Hans Olav & Moen, Atle & Ringard, Ånen & Norheim, Ole Frithjof, 2016. "A new proposal for priority setting in Norway: Open and fair," Health Policy, Elsevier, vol. 120(3), pages 246-251.
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    More about this item

    Keywords

    Decision making; Priority setting; Efficiency; Discrete choice experiment; Healthcare; Innovation; Germany;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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