Are Health State Valuations from the General Public Biased? A Test of Health State Reference Dependency Using Self‐assessed Health and an Efficient Discrete Choice Experiment

Background: Complex health and social care interventions impact on a multitude of outcomes. One such intervention is the Family Nurse Partnership (FNP) programme, which was introduced to support young, first-time mothers. Our study quantified the relative values that the general public place on the outcomes of FNP, as they were identified and measured in the relevant randomized trial, Building Blocks trial (BBs). Methods: A discrete choice experiment (DCE) was employed. Respondents chose between two scenarios describing hypothetical sets of trial outcomes. BBs compared FNP care for teenagers expecting their first child with standard NHS care. 14 attributes covered three areas: pregnancy and birth, child development and maternal life course. Due to large number of attributes, a “blocked attributes” approach was adopted: the attributes were split across four designs which contained two common attributes. Data were analysed separately for each design as well as pooled across four designs. Random effects probit model was employed for the analysis. Results: Over 1000 participants completed four designs. The analyses on the separate designs and those on pooled data yielded broadly similar results. Respondents valued higher the outcomes related to child development and their needs, followed by the outcomes related to maternal life course. Preferences varied by the age of the respondents but not by their guardianship/parentship status. Conclusions: Individual preferences were consistent with a priori expectations and were intuitive. The DCE results can be used to incorporate the general public preferences into the decision making process for which public health and social care policies should be adopted.

Download Full-text

Varying Opinions on Who Deserves Collectively Financed Health Care Services: A Discrete Choice Experiment on Allocation Preferences of the General Public

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958017751981 ◽

2018 ◽

Vol 55 ◽

pp. 004695801775198

Author(s):

Maartje J. van der Aa ◽

Aggie T. G. Paulus ◽

Mickaël J. C. Hiligsmann ◽

Johannes A. M. Maarse ◽

Silvia M. A. A. Evers

Keyword(s):

Health Care ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

General Public ◽

Choice Experiment ◽

Access To Health Care ◽

Health Care Services ◽

Insurance Coverage ◽

Financial Capacity ◽

Medical Needs

In Europe, health insurance arrangements are under reform. These arrangements redistribute collectively financed resources to ensure access to health care for all. Allocation of health services is historically based on medical needs, but use of other criteria, such as lifestyle, is debated upon. Does the general public also have preferences for conditional allocation? This depends on their opinions regarding deservingness. The aim of this study was to gain insight in those opinions, specifically by examining the perceived weight of different criteria in allocation decisions. Based on literature and expert interviews, we included 5 criteria in a discrete choice experiment: need, financial capacity, lifestyle, cooperation with treatment, and package/premium choice. A representative sample of the Dutch population was invited to participate (n = 10 760). A total of 774 people accessed the questionnaire (7.2%), of whom 375 completed it (48.4%). Medical need was overall the most important criterion in determining deservingness (range β = 1.60). Perceived deservingness decreased if claimants had higher financial capacity (1.26) and unhealthier lifestyle (1.04), if their cooperation was less optimal (1.05), or if they had opted for less insurance coverage (0.56). However, preferences vary among respondents, in relation to demographic and ideological factors.

Download Full-text