title: Public views on principles for health care priority setting: findings of a European cross-country study using Q methodology.
abstract: Resources available to the health care sector are finite and typically insufficient to fulfil all the demands for health care in the population. Decisions must be made about which treatments to provide. Relatively little is known about the views of the general public regarding the principles that should guide such decisions. We present the findings of a Q methodology study designed to elicit the shared views in the general public across ten countries regarding the appropriate principles for prioritising health care resources. In 2010, 294 respondents rank ordered a set of cards and the results of these were subject to by-person factor analysis to identify common patterns in sorting. Five distinct viewpoints were identified, (I) "Egalitarianism, entitlement and equality of access"; (II) "Severity and the magnitude of health gains"; (III) "Fair innings, young people and maximising health benefits"; (IV) "The intrinsic value of life and healthy living"; (V) "Quality of life is more important than simply staying alive". Given the plurality of views on the principles for health care priority setting, no single equity principle can be used to underpin health care priority setting. Hence, the process of decision making becomes more important, in which, arguably, these multiple perspectives in society should be somehow reflected.
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands. Electronic address: vanexel@bmg.eur.nl.
authors.forename: Job
authors.initials: J
authors.lastname: van Exel
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, G4 OBA, Scotland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Baker
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, G4 OBA, Scotland.
authors.forename: Helen
authors.initials: H
authors.lastname: Mason
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, G4 OBA, Scotland.
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: Werner
authors.initials: W
authors.lastname: Brouwer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003657:Decision Making; D005060:Europe; D005163:Factor Analysis, Statistical; D005260:Female; D015276:Health Care Rationing / Q000191:economics; D006292:Health Priorities / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D011639:Public Opinion; D055815:Young Adult
keywords: Decision making; Equity; Europe; Health care; Q methodology; QALYs; Resource allocation; Social values