title: Are all health gains equally important? An exploration of acceptable health as a reference point in health care priority setting.
abstract: BACKGROUND
  Accumulating evidence suggests that members of society prefer some QALY gains over others. In this paper, we explore the notion of acceptable health as a reference point in assessing the value of health gains. The value of health benefits may be assessed in terms of their position relative to this reference level, benefits above the level of acceptable health being valued differently from benefits below this level. In this paper we focus on assessing the level of acceptable health at different ages and associations with background variables.
  
  
  METHODS
  We recruited a sample of the adult population from the Netherlands (n = 1067) to investigate which level of health problems they consider to be acceptable for people aged 40 to 90, using 10-year intervals. We constructed acceptable health curves and associated acceptable health with background characteristics using linear regressions.
  
  
  RESULTS
  The results of this study indicate that the level of health problems considered acceptable increases with age. This level was associated with respondents' age, age of death of next of kin, health and health behaviour.
  
  
  CONCLUSIONS
  Our results suggest that people are capable of indicating acceptable levels of health at different ages, implying that a reference point of acceptable health may exist. While more investigation into the measurement of acceptable health remains necessary, future studies may also focus on how health gains may be valued relative to this reference level. Gains below the reference point may receive higher weight than those above this level since the former improve unacceptable health states while the latter improve acceptable health states.
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, 3000, DR, Rotterdam, The Netherlands. wouters@bmg.eur.nl.
authors.forename: S
authors.initials: S
authors.lastname: Wouters
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, 3000, DR, Rotterdam, The Netherlands. vanexel@bmg.eur.nl.
authors.forename: N J A
authors.initials: NJ
authors.lastname: van Exel
authors.affiliation: Erasmus School of Economics, Erasmus University Rotterdam, 3000, DR, Rotterdam, The Netherlands. rohde@ese.eur.nl.
authors.forename: K I M
authors.initials: KI
authors.lastname: Rohde
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, 3000, DR, Rotterdam, The Netherlands. brouwer@bmg.eur.nl.
authors.forename: W B F
authors.initials: WB
authors.lastname: Brouwer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D015438:Health Behavior; D006292:Health Priorities / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011788:Quality of Life