title: Does responsibility affect the public's valuation of health care interventions? A relative valuation approach to health care safety.
abstract: OBJECTIVE
  Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible.
  
  
  METHODS
  An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or "matching" method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off.
  
  
  RESULTS
  Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41).
  
  
  CONCLUSIONS
  Our results suggest that people do not attach a simple fixed premium to "safety-related" interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature.
authors.affiliation: Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH), Brunel University, Uxbridge, Middlesex, UK. jeshika.singh@brunel.ac.uk
authors.forename: Jeshika
authors.initials: J
authors.lastname: Singh
authors.forename: Joanne
authors.initials: J
authors.lastname: Lord
authors.forename: Louise
authors.initials: L
authors.lastname: Longworth
authors.forename: Shepley
authors.initials: S
authors.lastname: Orr
authors.forename: Teresa
authors.initials: T
authors.lastname: McGarry
authors.forename: Rob
authors.initials: R
authors.lastname: Sheldon
authors.forename: Martin
authors.initials: M
authors.lastname: Buxton
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000517:prevention & control; D001294:Attitude to Health; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D030342:Genetic Diseases, Inborn / Q000453:epidemiology; D040261:Harm Reduction; D006801:Humans; D020407:Internet; D008019:Life Style; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D060051:Occupational Injuries / Q000517:prevention & control; D057240:Patient Preference; D061214:Patient Safety; D012945:Social Values; D006113:United Kingdom; D055815:Young Adult