van der Aa Maartje J, Paulus Aggie T G, Hiligsmann Mickaël J C, Maarse Johannes A M, Evers Silvia M A A
1 Maastricht University, The Netherlands.
Inquiry. 2018 Jan-Dec;55:46958017751981. doi: 10.1177/0046958017751981.
In Europe, health insurance arrangements are under reform. These arrangements redistribute collectively financed resources to ensure access to health care for all. Allocation of health services is historically based on medical needs, but use of other criteria, such as lifestyle, is debated upon. Does the general public also have preferences for conditional allocation? This depends on their opinions regarding deservingness. The aim of this study was to gain insight in those opinions, specifically by examining the perceived weight of different criteria in allocation decisions. Based on literature and expert interviews, we included 5 criteria in a discrete choice experiment: need, financial capacity, lifestyle, cooperation with treatment, and package/premium choice. A representative sample of the Dutch population was invited to participate (n = 10 760). A total of 774 people accessed the questionnaire (7.2%), of whom 375 completed it (48.4%). Medical need was overall the most important criterion in determining deservingness (range β = 1.60). Perceived deservingness decreased if claimants had higher financial capacity (1.26) and unhealthier lifestyle (1.04), if their cooperation was less optimal (1.05), or if they had opted for less insurance coverage (0.56). However, preferences vary among respondents, in relation to demographic and ideological factors.
在欧洲，医疗保险安排正在改革。这些安排重新分配集体筹集的资源，以确保所有人都能获得医疗保健服务。医疗服务的分配历来基于医疗需求，但对于是否使用其他标准（如生活方式）存在争议。普通公众对于有条件分配是否也有偏好呢？这取决于他们对于应得性的看法。本研究的目的是深入了解这些看法，特别是通过考察不同标准在分配决策中被感知到的权重。基于文献和专家访谈，我们在一项离散选择实验中纳入了5个标准：需求、经济能力、生活方式、与治疗的配合度以及套餐/保费选择。邀请了荷兰人口的一个代表性样本参与（n = 10760）。共有774人访问了问卷（7.2%），其中375人完成了问卷（48.4%）。总体而言，医疗需求是确定应得性时最重要的标准（β值范围为1.60）。如果索赔者经济能力较强（1.26）、生活方式不健康（1.04）、与治疗的配合度欠佳（1.05）或者选择的保险覆盖范围较小（0.56），则其被感知到的应得性会降低。然而，受访者的偏好因人口统计学和意识形态因素而有所不同。
