Public preferences for the allocation of societal resources over different healthcare purposes.

OBJECTIVE: Increasing healthcare expenditures require governments to make difficult prioritization decisions. Considering public preferences can help raise citizens' support. Previous research has predominantly elicited preferences for the allocation of public resources towards specific treatments or patient groups and principles for resource allocation. This study contributes by examining public preferences for budget allocation over various healthcare purposes in the Netherlands. METHODS: We conducted a Participatory Value Evaluation (PVE) choice experiment in which 1408 respondents were asked to allocate a hypothetical budget over eight healthcare purposes: general practice and other easily accessible healthcare, hospital care, elderly care, disability care, mental healthcare, preventive care by encouragement, preventive care by discouragement, and new and better medicines. A default expenditure was set for each healthcare purpose, based on current expenditures. Respondents could adjust these default expenditures using sliders and were presented with the implications of their adjustments on health and well-being outcomes, the economy, and the healthcare premium. As a constraint, the maximum increase in the mandatory healthcare premium for adult citizens was €600 per year. The data were analysed using descriptive statistics and a Latent Class Cluster Analysis (LCCA). RESULTS: On average, respondents preferred to increase total expenditures on all healthcare purposes, but especially on elderly care, new and better medicines, and mental healthcare. Three preference clusters were identified. The largest cluster preferred modest increases in expenditures, the second a much higher increase of expenditures, and the smallest favouring a substantial reduction of the healthcare premium by decreasing the expenditure on all healthcare purposes. The analyses also demonstrated substantial preference heterogeneity between clusters for budget allocation over different healthcare purposes. CONCLUSIONS: The results of this choice experiment show that most citizens in the Netherlands support increasing healthcare expenditures. However, substantial heterogeneity was identified in preferences for healthcare purposes to prioritize. Considering these preferences may increase public support for prioritization decisions.

Unveiling the controversy on egg freezing in The Netherlands: A Q-methodology study on women's viewpoints.

Preserving the option to conceive through egg freezing (oocyte cryopreservation) is surrounded by value conflicts and diverse viewpoints, particularly when non-medical or so-called 'social' reasons are involved. The debate is controversial and shaped by normative perceptions of the life course, including concepts regarding reproductive ageing, gender, motherhood and biomedicalization. To unravel the controversy and systematically identify the variety of viewpoints on egg freezing, a Q-methodology study was conducted in The Netherlands between December 2018 and October 2019. Thirty-four women of reproductive age participated in the study. They ranked 40 statements according to their level of agreement, and explained their ranking during follow-up interviews. Data were analysed using by-person factor analysis and interpreted using both quantitative and qualitative data. Four viewpoints, of which the fourth was bipolar, were identified: (1) cautious about egg freezing technology; (2) my body, my choice; (3) egg freezing is unnatural; and (4) have children and have them early. The distinct viewpoints illustrate different prioritizations of values and normative dimensions of biomedical innovations. By knowing more about the prevalent opinions on egg freezing and the surrounding controversy, policy makers and practitioners can make better informed decisions in terms of promoting and providing patient-centred infertility care. The findings furthermore stimulate continuing scholarly work on egg freezing and other innovations in reproductive medicine which may continue to disrupt normative standards.

Valid Outcome Measures in Care for Older People: Comparing the ASCOT and the ICECAP-O.

BACKGROUND: Limited health care budgets and population aging result in a need to compare care services on their benefits and costs. Because services for older people often aim to improve multiple life aspects, valid measures are needed to examine their benefits on individuals' health and well-being simultaneously. Two measures may meet this end: the Adult Social Care Outcomes Toolkit (ASCOT) and the ICEpop CAPability measure for Older people (ICECAP-O). OBJECTIVES: To compare the validity of both measures, the ASCOT and the ICECAP-O. METHODS: A sampling agency gathered cross-sectional data in May 2015. Using exploratory factor analysis, the underlying factor structure of the ASCOT and the ICECAP-O was examined for the first time. Convergent and discriminant validity in relation to health measures (five-level EuroQol five-dimensional questionnaire, EuroQol Visual Analogue Scale, Barthel Index, and Geriatric Depression Scale-15) and well-being measures (Older People's Quality of Life Questionnaire-13, Satisfaction with Life Scale, and Cantril's Ladder) were tested using Spearman rank correlations and variance analysis. RESULTS: The ASCOT and the ICECAP-O tapped into a shared factor, whereas both measures also loaded on two separate factors. The ASCOT and the ICECAP-O correlated highly with the health and well-being measures, but the correlation with the physical health measure Barthel Index was moderate. Both measures discriminated between subgroups of respondents. CONCLUSIONS: The ASCOT and the ICECAP-O seem promising measures to evaluate well-being among older people, whereby the ASCOT seems more specific to social care-related outcomes. The performance of both measures in other respondent groups and countries, and their relation to physical health, need to be further examined before their use in economic evaluations can be recommended.

Does the EQ-5D reflect lost earnings?

BACKGROUND: An important methodological issue in economic evaluations of healthcare is how to include productivity costs (the costs related to reduced productivity due to illness, disability and premature death). Traditionally, they were included in the numerator of a cost-effectiveness analysis, through either the human-capital or the friction-cost method. It has been argued, however, that productivity costs are already included in the denominator (i.e. in the QALY measure) because respondents consider the effect a given health state will have on their income when valuing health states. If that is the case, many previous economic evaluations might have double counted productivity costs by including them in both the numerator and the denominator. AIM: The aim of this study was to determine whether respondents valuing EQ-5D health states using the time trade-off (TTO) method spontaneously consider income effects, whether this consideration influences subsequent valuations and whether explicit ex post instructions influence valuations. METHODS: Through an online survey, we asked 321 members of the Dutch general population to value four EQ-5D health states through three different TTO exercises. The first exercise was a standard TTO question. Respondents were then asked whether they had included income effects. Depending on their answer, the second TTO exercise instructed them to either include or exclude income effects. The third TTO exercise provided explicit information regarding the income loss associated with the health state. RESULTS: Data were available from 321 members of the Dutch general public. Of these respondents, 49% stated they had spontaneously included income effects. Twenty-five percent of the sample did not trade any time in any of the TTO exercises and these respondents were excluded from the analysis. Results of t-tests showed there were only weakly significant differences in valuations for one health state between those who spontaneously included income effects and those who did not. Explicit instruction led to some significant differences at the aggregate level, but the effect was inconsistent at the individual level. When explicit information on the amount of income loss was provided, all states were valued lower when associated with a larger income loss. CONCLUSIONS: This study offers further evidence indicating that income losses do not significantly affect health state valuations.