Preferences for investment in and allocation of additional healthcare capacity. (March 2023)

• Record Type: Journal Article
• Authors: van Hulsen, Merel A.J.; Rohde, Kirsten I.M.; van Exel, Job
• Is Part Of: Social science & medicine. Volume 320(2023)
• Publication Date: 2023-03
• Subjects: Resource allocation -- Priority setting -- Waiting lists -- Public preferences -- Efficiency -- Equity; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2023.115717
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Policy makers need to make decisions regarding the allocation of scarce healthcare resources. We study preferences for investment in additional healthcare capacity and allocation between two regions, focusing on reducing waiting time for elective surgery for a physical health problem. We elicit preferences from a societal and an individual perspective, with unequal initial waiting times between the two regions. In an online survey, 1039 respondents were randomly assigned to one of three versions of the experiment: (1) a social planner perspective, placing respondents in the role of a policy maker; (2) an individual perspective where the respondent's own region was better off regarding initial waiting times; (3) an individual perspective where the individual's own region was worse off regarding initial waiting times. Respondents were asked to rank the status quo and five scenarios where the investment in additional capacity led to different distributions of shorter waiting times between regions. For all allocations we presented both the reduction in waiting time and the resulting final waiting time for both regions. We find that in version 1 of the experiment, preferences were in line with inequality aversion and Rawlsian preferences regarding final waiting time. In version 3, similar preferences were found, although here they also align with individualistic preferences. In version 2, preferences were more heterogeneous, with both individualistic and egalitarian preferences present. Concluding, individualistic and egalitarian preferences mostly concerned final waiting time. We therefore recommend policy makers to focus on the effect on final waiting time instead of the reduction of waiting time. Highlights: We studied preferences for investment and allocation of extra healthcare capacity. From societal planner perspective, inequality aversion and worse-off were prioritized. From individual better-off perspective, selfish and egalitarian preferences relevant. From individual worse-off perspective, selfish preferences were relatively stronger. In all perspectives, final waiting times more important than waiting time reductions.