Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-15T06:47:54.816Z Has data issue: false hasContentIssue false

Social preferences for prioritising the treatment of disabled and chronically ill patients: beyond the order effect

Published online by Cambridge University Press:  08 May 2018

John Mckie*
Affiliation:
Centre for Health Economics, Monash University, Clayton, VIC, Australia
Jeff Richardson
Affiliation:
Centre for Health Economics, Monash University, Clayton, VIC, Australia
*
*Correspondence to: John McKie, Centre for Health Economics, Monash University, Clayton, VIC 3800, Australia. Email: jrmckie@bigpond.com

Abstract

Previous evidence suggests that members of the public value life saving services differently when they are for patients with a pre-existing permanent disability and when they are for patients who become disabled at the onset of treatment – for example, as a result of treatment that is not entirely effective. However, the valuation of services in these two cases has also been found to differ with the order in which they are presented in a population survey. This casts doubt upon the validity of the results and leaves unresolved the nature of the public’s true preferences. The study reported here had three main objectives: (i) to determine the considered, underlying preferences of a sample of the Australian public with respect to the treatment of the permanently disabled and chronically ill, (ii) to gain insight into the reasons for respondent’s distributive preferences and (iii) to eliminate or significantly reduce the order effect. Eight semi-structured, small-group discussions were held with 66 members of the public in Victoria, Australia. Order effects were effectively eliminated. The study found substantial support among participants for the equal treatment of the permanently disabled and chronically ill regardless of when the problem commenced.

Type
Articles
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abellan-Perpiñán, J.-M. and Prades, J.-L. P. (1999), ‘Health state after treatment: a reason for discrimination?’, Health Economics, 8(8): 701707.Google Scholar
Abelson, J., Eyles, J., McLeod, C. B., Collins, P., McMullan, C. and Forest, P.-G. (2003), ‘Does deliberation make a difference: results from a Citizens Panel Study of health goals priority setting’, Health Policy, 66(1): 95106.Google Scholar
Anand, P. (1993), ‘The philosophy of intransitive preference’, The Economic Journal, 103(417): 337346.Google Scholar
Bahena-Salgado, Y. and Bernal-Márquez, J. (2007), ‘Quality of life of patients with paraplegia secondary to traumatic spine injury’, Acta Ortopédica Mexicana, 21(1): 37.Google Scholar
Bender, D. and Ewbank, D. (1994), ‘The focus group as a tool for health research: issues in design and analysis’, Health Transition Review, 4(1): 6380.Google Scholar
Bradburn, N. M. (1992), ‘What have we learned?’, in N. Schwarz and S. Sudman (eds), Context Effects in Social and Psychological Research, New York: Springer, 315323.Google Scholar
Damschroder, L. J., Zikmund-Fisher, B. J. and Ubel, P. A. (2005), ‘The impact of considering adaptation in health state valuation’, Social Science and Medicine, 61(2): 267277.Google Scholar
Daniels, N. (1998), ‘Symposium on the rationing of health care: 2 rationing medical care – a philosopher’s perspective on outcomes and process’, Economics and Philosophy, 14(1): 2750.Google Scholar
Diederich, A., Winkelhage, J. and Wirsik, N. (2011), ‘Age as a criterion for setting priorities in health care? A survey of the German public view’, PLoS ONE, 6(8): e23930.Google Scholar
Dolan, P. and Cookson, R. (2000), ‘A qualitative study of the extent to which health gain matters when choosing between groups of patients’, Health Policy, 51(1): 1930.Google Scholar
Dolan, P. and Tsuchiya, A. (2012), ‘It is the lifetime that matters: public preferences over maximising health and reducing inequalities in health’, Journal of Medical Ethics, 38(9): 571573.Google Scholar
Eisenberg, D., Freed, G., Davis, M., Singer, D. and Prosser, L. (2011), ‘Valuing health at different ages’, Applied Health Economics and Health Policy: Evidence From a Nationally Representative Survey in the US, 9(3): 149156.Google Scholar
Finch, H. and Lewis, J. (2003), ‘Chap. 7: Focus Groups’, in J. Ritchie and J. Lewis (eds), Qualitative Research Practice, Thousand Oaks, CA: Sage Publications.Google Scholar
Freeman, S. (2000), ‘Deliberative democracy: a sympathetic comment’, Philosophy and Public Affairs, 29(4): 371418.Google Scholar
Hakli, R., Miller, K. and Tuomela, R. (2010), ‘Two kinds of we-reasoning’, Economics and Philosophy, 26(3): 291320.Google Scholar
Harris, J. (1987), ‘QALYfying the value of life’, Journal of Medical Ethics, 13(3): 117123.Google Scholar
Hesse-Biber, S. N. and Leavy, P. (2006), The Practice of Qualitative Research, Thousand Oaks, CA: Sage Publications.Google Scholar
Jönsson, B. (2009), ‘Ten arguments for a societal perspective in the economic evaluation of medical innovations’, The European Journal of Health Economics, 10(4): 357359.Google Scholar
Krosnick, J. A. (1992), ‘The Impact of Cognitive Sophistication and Attitude Importance on Response-order and Question-order Effects’, in N. Schwarz and S. Sudman (eds), Context Effects in Social and Psychological Research, New York: Springer, 203218.Google Scholar
Krosnick, J. A. and Alwin, D. F. (1987), ‘An evaluation of a cognitive theory of response-order effects in survey measurement’, Public Opinion Quarterly, 51(2): 201219.Google Scholar
McKie, J., Shrimpton, B., Richardson, J. and Hurworth, R. (2011), ‘The monetary value of a life year: evidence from a qualitative study of treatment costs’, Health Economics, 20(8): 945957.Google Scholar
Mitton, C., Smith, N., Peacock, S., Evoy, B. and Abelson, J. (2009), ‘Public participation in health care priority setting: a scoping review’, Health Policy, 91(3): 219228.Google Scholar
Morgan, D. L. (1997), Focus Groups as Qualitative Research, 2nd edn, Thousand Oaks, CA: Sage Publications.Google Scholar
Morgan, D. L. and Spanish, M. T. (1984), ‘Focus groups: a new tool for qualitative research’, Qualitative Sociology, 7(3): 253270.Google Scholar
NHS (2013), Transforming Participation in Health and Care. NHS, England. http://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf [14 November 2014].Google Scholar
Nord, E. (1999), Cost-Value Analysis in Health Care, Cambridge: Cambridge University Press.Google Scholar
Nord, E. (2013), ‘Priority to the Worse Off: Severity of Current and Future Illness Versus Shortfall in Lifetime Health’, in N. Eyal, S. Hurst, O. Norheim and D. Wikler (eds), Inequalities in Health: Concepts, Measures, and Ethics, Oxford: Oxford University Press, 66--73.Google Scholar
Nord, E. and Johansen, R. (2014), ‘Concerns for severity in priority setting in health care: a review of trade-off data in preference studies and implications for societal willingness to pay for a QALY’, Health Policy, 116(2–3): 281288.Google Scholar
Nord, E., Richardson, J., Street, A., Kuhse, H. and Singer, P. (1995a), ‘Maximizing health benefits vs egalitarianism: an Australian survey of health issues’, Social Science and Medicine, 41(10): 14291437.Google Scholar
Nord, E., Richardson, J., Street, A., Kuhse, H. and Singer, P. (1995b), ‘Who cares about cost? Does economic analysis impose or reflect social values?’, Health Policy, 34(2): 7994.Google Scholar
Nord, E., Undrum Enge, A. and Gundersen, V. (2010), ‘QALYS: is the value of treatment proportional to the size of the health gain?’, Health Economics, 19(5): 596607.Google Scholar
Normand, C. (2009), ‘Measuring outcomes in palliative care: limitations of QALYs and the road to PalYs’, Journal of Pain and Symptom Management, 38(1): 2731.Google Scholar
Olsen, J. A. (2013), ‘Priority preferences: “End of Life” does not matter, but total life does’, Value in Health, 16(6): 10631066.Google Scholar
Ottersen, T., Maestad, O. and Norheim, O. (2014), ‘Lifetime QALY prioritarianism in priority setting: quantification of the inherent trade-off’, Cost Effectiveness and Resource Allocation, 12(2), https://doi.org/10.1186/1478-7547-12-2 [26 April 2016].Google Scholar
Palanca-Tan, R. (2013), ‘Age preferences for life-saving programs: using choice modeling to measure the relative values of statistical life’, The Singapore Economic Review, 58(02): 1350008.Google Scholar
Patrick, D. L., Starks, H. E., Cain, K. C., Uhlmann, R. F. and Pearlman, R. A. (1994), ‘Measuring preferences for health states worse than death’, Medical Decision Making, 14(1): 918.Google Scholar
Patton, M. Q. (2002), Qualitative Research and Evaluation Methods, Thousand Oaks, CA: Sage Publications.Google Scholar
Petrou, S., Kandala, N.-B., Robinson, A. and Baker, R. (2013), ‘A person trade-off study to estimate age-related weights for health gains in economic evaluation’, PharmacoEconomics, 31(10): 893907.Google Scholar
Rawls, J. (1971), A Theory of Justice, Cambridge: Harvard University Press.Google Scholar
Roberts, J. and Dolan, P. (2004), ‘To what extent do people prefer health states with higher values? A note on evidence from the EQ-5D valuation set’, Health Economics, 13(7): 733737.Google Scholar
Roberts, T., Bryan, S., Heginbotham, C. and McCallum, A. (1999), ‘Public involvement in health care priority setting: an economic perspective’, Health Expectations, 2(4): 235244.Google Scholar
Round, J. (2012), ‘Is a QALY still a QALY at the end of life?’’, Journal of Health Economics, 31(3): 521527.Google Scholar
Schwarz, N., Hippler, H.-J. and Noelle-Neumann, E. (1992), ‘A Cognitive Model of Response-Order Effects in Survey Measurement’, in N. Schwarz and S. Sudman (eds), Context Effects in Social and Psychological Research, New York: Springer, 187201.Google Scholar
Sen, A. (1985), ‘Well-being, agency and freedom: the Dewey Lectures, 1984’, Journal of Philosophy, 82(4): 169221.Google Scholar
Shah, K. K. (2009), ‘Severity of illness and priority setting in healthcare: a review of the literature’, Health Policy, 93(2–3): 7784.Google Scholar
Shah, K. K., Tsuchiya, A. and Wailoo, A. (2014), ‘Valuing health at the end of life: an empirical study of public preferences’, The European Journal of Health Economics, 15(4): 389399.Google Scholar
Stewart, D. W. and Shamdasani, P. N. (1990), Focus Groups: Theory and Practice, Newbury Park: Sage Publications.Google Scholar
Stolk, E. A., Pickee, S. J., Ament, A. H. J. A. and Busschbach, J. J. V. (2005), ‘Equity in health care prioritisation: an empirical inquiry into social value’, Health Policy, 74(3): 343355.Google Scholar
Sudman, S., Bradburn, N. M. and Schwarz, N. (1996), Thinking About Answers: The Application of Cognitive Processes to Survey Methodology, San Francisco: Jossey-Bass Publishers.Google Scholar
Tourangeau, R., Singer, E. and Presser, S. (2003), ‘Cognitive effects in attitude surveys: effects on remote items and impact on predictive validity’, Sociological Methods and Research, 31(4): 486513.Google Scholar
Ubel, P. A., Richardson, J. and Baron, J. (2002), ‘Exploring the role of order effects in person trade-off elicitations’, Health Policy, 61(2): 189199.Google Scholar
Ubel, P. A., Loewenstein, G., Scanlon, D. and Kamlet, M. (1996), ‘Individual utilities are inconsistent with rationing choices: a partial explanation of why Oregons cost-effectiveness list failed’, Medical Decision Making, 16(2): 108116.Google Scholar
van Hout, B., Janssen, M. F., Feng, Y.-S., Kohlmann, T., Busschbach, J., Golicki, D., Lloyd, A., Scalone, L., Kind, P. and Pickard, A. S. (2012), ‘Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets’, Value in Health, 15(5): 708715.Google Scholar
Van Vleet, J. E. (2011), Informal Logical Fallacies, Maryland: University Press of America.Google Scholar
Weinstein, M. C. and Stason, W. B. (1977), ‘Foundations of cost-effectiveness analysis for health and medical practices’’, New England Journal of Medicine, 296(13): 716721.Google Scholar
Supplementary material: File

Mckie and Richardson supplementary material 1

Mckie and Richardson supplementary material

Download Mckie and Richardson supplementary material 1(File)
File 11.7 KB

Mckie and Richardson supplementary material 2

Mckie and Richardson supplementary material

Download Mckie and Richardson supplementary material 2(Audio)
Audio 20.2 KB
Supplementary material: File

Mckie and Richardson supplementary material 3

Mckie and Richardson supplementary material

Download Mckie and Richardson supplementary material 3(File)
File 13.3 KB
Supplementary material: File

Mckie and Richardson supplementary material 4

Supplementary Table

Download Mckie and Richardson supplementary material 4(File)
File 19.4 KB
Supplementary material: File

Mckie and Richardson supplementary material 5

Supplementary Table

Download Mckie and Richardson supplementary material 5(File)
File 21.3 KB
Supplementary material: File

Mckie and Richardson supplementary material 6

Supplementary Table

Download Mckie and Richardson supplementary material 6(File)
File 20.4 KB
Supplementary material: File

Mckie and Richardson supplementary material 7

Supplementary Table

Download Mckie and Richardson supplementary material 7(File)
File 21.7 KB
Supplementary material: File

Mckie and Richardson supplementary material 8

Supplementary Table

Download Mckie and Richardson supplementary material 8(File)
File 22.6 KB
Supplementary material: File

Mckie and Richardson supplementary material 9

Supplementary Table

Download Mckie and Richardson supplementary material 9(File)
File 18.5 KB