Methods to Determine Health Care Priorities Questioned

Debate over whether to base resource allocation on measures of patient or public attitudes
By Jeff Muise
HealthDay Reporter

FRIDAY, July 23 (HealthDay News) -- Evaluating health care priorities based on the attitudes of patients (direct method) or the attitudes of the general public (indirect method) can produce different results, complicating decisions on the allocation of health care resources, according to two papers published July 22 in BMJ.

In one study, David Arnold, of Cardiff University Medical School in the United Kingdom, and colleagues reviewed 32 studies on resource allocation and compared the direct and indirect methods for determining health care priorities. The indirect method, using attitudes of the general public, tended to favor the allocation of health care resources away from death-delaying interventions to the alleviation of non-fatal conditions.

In the second paper, Paul Dolan, Ph.D., of Imperial College Business School in London, and colleagues question the usefulness of the European quality of life five dimensions survey (EQ-5D) recommended by the National Institute for Health and Clinical Excellence to determine health care priorities. The researchers argue that the survey is hypothetical and too narrowly focused on the dimensions, and they advocate a tool that measures "subjective well-being."

"We suggest that subjective well-being offers a more direct and accurate way of assessing how health states impact on the lives of those most affected by different health conditions. The move would mean that we are not constrained to using simple descriptive systems like the EQ-5D," Dolan and colleagues write. "It makes sense to focus on the (sometimes different) dimensions of health that have the greatest effect on the lives of all those affected by different conditions."

Abstract - Arnold
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Abstract - Dolan
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