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Decision-making criteria among national policymakers in five countries: A discrete choice experiment eliciting relative preferences for equity and efficiency

Mirelman, Andrew; Mentzakis, Emmanouil; Kinter, Elizabeth; Paolucci, Francesco; Fordham, Richard; Ozawa, Sachiko; Ferraz, Marcos; Baltussen, Rob; Niessen, Louis

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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,...[Show more]

dc.contributor.authorMirelman, Andrew
dc.contributor.authorMentzakis, Emmanouil
dc.contributor.authorKinter, Elizabeth
dc.contributor.authorPaolucci, Francesco
dc.contributor.authorFordham, Richard
dc.contributor.authorOzawa, Sachiko
dc.contributor.authorFerraz, Marcos
dc.contributor.authorBaltussen, Rob
dc.contributor.authorNiessen, Louis
dc.date.accessioned2015-12-10T23:04:24Z
dc.identifier.issn1098-3015
dc.identifier.urihttp://hdl.handle.net/1885/62357
dc.description.abstractBackground: 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.
dc.publisherWiley-Blackwell
dc.sourceValue in Health
dc.subjectKeywords: article; Brazil; comparative study; controlled study; Cuba; decision making; disease severity; health care policy; health status; life expectancy; Nepal; Norway; priority journal; probability; questionnaire; Uganda; Administrative Personnel; Brazil; Choic discrete choice experiment; efficiency; equity; priority setting
dc.titleDecision-making criteria among national policymakers in five countries: A discrete choice experiment eliciting relative preferences for equity and efficiency
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume15
dc.date.issued2012
local.identifier.absfor111708 - Health and Community Services
local.identifier.absfor140208 - Health Economics
local.identifier.ariespublicationf5625xPUB691
local.type.statusPublished Version
local.contributor.affiliationMirelman, Andrew, Johns Hopkins University
local.contributor.affiliationMentzakis, Emmanouil , University of East Anglia
local.contributor.affiliationKinter, Elizabeth , Johns Hopkins University
local.contributor.affiliationPaolucci, Francesco, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationFordham, Richard , University of East Anglia
local.contributor.affiliationOzawa, Sachiko, Johns Hopkins University
local.contributor.affiliationFerraz, Marcos, Federal University of Sao Paulo
local.contributor.affiliationBaltussen, Rob, Radboud University
local.contributor.affiliationNiessen, Louis, Johns Hopkins University
local.description.embargo2037-12-31
local.bibliographicCitation.issue3
local.bibliographicCitation.startpage534
local.bibliographicCitation.lastpage539
local.identifier.doi10.1016/j.jval.2012.04.001
dc.date.updated2016-02-24T09:31:46Z
local.identifier.scopusID2-s2.0-84861143305
local.identifier.thomsonID000303940600017
CollectionsANU Research Publications

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