title: Decision-making criteria among national policymakers in five countries: a discrete choice experiment eliciting relative preferences for equity and efficiency.
abstract: BACKGROUND
  Worldwide, there is a need for formalization of the priority setting processes in health. Recent research has used the term multicriteria decision analysis for methods that systematically include preferences for both equity and efficiency. The present study compares decision-makers' preferences at the country level for a set of equity and efficiency criteria according to a multicriteria decision analysis framework.
  
  
  METHODS
  Discrete choice experiments were conducted for Brazil, Cuba, Nepal, Norway, and Uganda. By using standardized methods, we elicited preferences for intervention attributes using a individual choice questionnaire. A multinomial logistic regression was applied to estimate the coefficients for all single-policy criteria, per country. Attributes were assigned to an equity group or to an efficiency group. After testing for scale variance, predicted probabilities for interventions with both types of attributes were compared across countries.
  
  
  RESULTS
  The Norway and Nepal groups showed considerable preferences for efficiency criteria over equity criteria with percent change in respective predicted sum probabilities of [10%, -84%] and [6%, -79%]. Brazil and Uganda also showed preference for the efficiency criteria though less convincingly ([-34%, -93%], [-18%, -63%], respectively). The Cuban group showed the strongest preferences with equity attributes dominating efficiency ([-52%, 213%]).
  
  
  CONCLUSIONS
  Group preferences of policymakers show explicit but varying trade-offs of efficiency and equity in these diverse settings. This multicriteria decision analysis approach, using discrete choice experiments, indicates that systematic setting of health priorities is possible across a variety of countries. It may be a valuable tool to guide health reform initiatives.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. amirelma@jhsph.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Mirelman
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Mentzakis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kinter
authors.forename: Francesco
authors.initials: F
authors.lastname: Paolucci
authors.forename: Richard
authors.initials: R
authors.lastname: Fordham
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ozawa
authors.forename: Marcos
authors.initials: M
authors.lastname: Ferraz
authors.forename: Rob
authors.initials: R
authors.lastname: Baltussen
authors.forename: Louis W
authors.initials: LW
authors.lastname: Niessen
mesh_terms: D000288:Administrative Personnel; D001938:Brazil; D002755:Choice Behavior; D003462:Cuba; D003695:Delivery of Health Care / Q000592:standards*; D017598:Efficiency, Organizational; D006291:Health Policy; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D009390:Nepal; D009664:Norway; D011050:Policy Making; D011795:Surveys and Questionnaires; D014454:Uganda