Health system goals: a discrete choice experiment to obtain societal valuations.
OBJECTIVE
To improve previous approaches to health system goals valuation.


METHODS
We reviewed literature on health system performance and previous comparative performance assessments, and combined this with literature on process utility to create a theoretical foundation for health system goals. We used a discrete choice experiment to elicit goal weights. To obtain social justice weights respondents were placed behind a 'veil of ignorance'. To ensure that respondents understood their task, we instructed them in a classroom setting.


RESULTS
We identified five health system goals. All five goals significantly affected choice behavior. An equitable distribution of health obtained the highest weight (0.34), followed by average level of health (0.29) and financial fairness (0.24). Both process outcomes (utility derived from the process and its distribution) received much lower weights (0.07 and 0.06, respectively).


CONCLUSIONS
Our framework adds to that of the World Health Organization. We demonstrated the feasibility of measuring societal valuation of health system goals with a multi-attribute technique based on trade-offs. Our weights placed much greater emphasis on health and health inequality than on process outcomes. Our study improves the methodology of international health system performance comparison and thereby enhances global evidence-based health policy information.
Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. Electronic address: franken@bmg.eur.nl.
Margreet
M
Franken
Xander
X
Koolman
D002755:Choice Behavior; D003695:Delivery of Health Care; D038622:Internationality; D008962:Models, Theoretical; D009426:Netherlands; D009937:Organizational Objectives; D012945:Social Values
Discrete choice experiment; Health policy; Health system goals; Health system performance; International comparison; Valuation