Soliciting Public Preferences For Health Care Priorities: A Critical Review of Methodologies

Various health care reforms have included a mandate to solicit local preferences for health care priorities. There is little consensus with respect to defining the participants, outlining the types of decisions which are appropriate for public input or establishing the way in which public preferences can be incorporated into decision-making. This paper critically reviews the methodological approaches that have been used to solicit public preferences for health care priorities in publicly funded systems. Exercises to solicit public preferences were carried out in the United States, England, New Zealand and the Netherlands. These experiences are critically reviewed using a framework which outlines requirements for internal validity, generalizability, reliability and objectivity. While the process of soliciting public preferences is still in its infancy, the analysis demonstrated that some aspects of internal validity, generalizability, reliability and objectivity were being given due attention. Key to developing a methodologically sound process is an a priori definition of the public (e.g., citizens or advocacy groups), from which appropriate data collection, sampling and analytical techniques follow. The potential instability of public preferences supports the use of multiple methods of data collection to corroborate findings. There is a need to share the research data, analysis and findings with the community.