Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Health Expect. 2022 Feb;25(1):333-344. doi: 10.1111/hex.13385. Epub 2021 Nov 29.
It remains unclear whether there would be societal support for a lifestyle criterion for the healthcare priority setting. This study examines the viewpoints of experts in healthcare and the public regarding support for a lifestyle-related decision criterion, relative to support for the currently applied criteria, in the healthcare priority setting in the Netherlands.
We conducted a Q methodology study in samples of experts in healthcare (n = 37) and the public (n = 44). Participants (total sample N = 81) ranked 34 statements that reflected currently applied decision criteria as well as a lifestyle criterion for setting priorities in healthcare. The ranking data were subjected to principal component analysis, followed by oblimin rotation, to identify clusters of participants with similar viewpoints.
We identified four viewpoints. Participants with Viewpoint 1 believe that treatments that have been proven to be effective should be reimbursed. Those with Viewpoint 2 believe that life is precious and every effort should be made to save a life, even when treatment still results in a very poor state of health. Those with Viewpoint 3 accept government intervention in unhealthy lifestyles and believe that individual responsibility should be taken into account in reimbursement decisions. Participants with Viewpoint 4 attribute importance to the cost-effectiveness of treatments; however, when priorities have to be set, treatment effects are considered most important. All viewpoints were supported by a mix of public and experts, but Viewpoint 1 was mostly supported by experts and the other viewpoints were mostly supported by members of the public.
This study identified four distinct viewpoints on the healthcare priority setting in the Netherlands, each supported by a mix of experts and members of the public. There seems to be some, but limited, support for a lifestyle criterion-in particular, among members of the public. Experts seem to favour the decision criteria that are currently applied. The diversity in views deserves attention when policymakers want to adhere to societal preferences and increase policy acceptance.
目前尚不清楚在医疗保健重点设置方面，社会是否会支持生活方式标准。本研究考察了医疗保健专家和公众对生活方式相关决策标准的支持程度，相对于目前应用的标准，在荷兰的医疗保健重点设置方面。
我们在医疗保健专家（n=37）和公众（n=44）样本中进行了 Q 方法研究。参与者（总样本 N=81）对 34 条反映目前应用的决策标准以及医疗保健优先排序的生活方式标准的陈述进行了排名。对排名数据进行了主成分分析，然后进行斜交旋转，以确定具有相似观点的参与者集群。
我们确定了四个观点。观点 1 的参与者认为已被证明有效的治疗方法应该得到报销。观点 2 的参与者认为生命是宝贵的，应该尽一切努力挽救生命，即使治疗仍然导致非常糟糕的健康状况。观点 3 的参与者接受政府对不健康生活方式的干预，并认为在报销决策中应考虑个人责任。观点 4 的参与者重视治疗的成本效益；然而，当需要设定优先级时，治疗效果被认为是最重要的。所有观点都得到了专家和公众的支持，但观点 1 主要得到了专家的支持，而其他观点主要得到了公众的支持。
本研究确定了荷兰医疗保健重点设置的四个不同观点，每个观点都得到了专家和公众的混合支持。对于生活方式标准，似乎有一些但有限的支持，特别是在公众中。专家似乎倾向于目前应用的决策标准。当政策制定者希望遵守社会偏好并提高政策接受度时，观点的多样性值得关注。
