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Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders preferences

Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders preferences
Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders preferences

Background: The trade-off between efficiency and equity has been largely studied in the health economics literature and for countries with different types of health systems. Even if efficiency and equity are desired, it is not always feasible to attain both simultaneously. In Spain, the National Health System has historically been recognized for its universal access and free of charge provision, with good health outcomes. However, the recent increase in health expenditures together with the economic cycle has turned the orientation of health policy implementation towards efficiency, threatening universality and equity in the access to healthcare. Methods: A Discrete Choice Experiment was carried out to weigh priorities of policy-makers from different regions in Spain. A total of 69 valid questionnaires were collected and the preferences towards equity and/or efficiency criteria were evaluated. Composite League Tables (CLTs) were used to rank hypothetical health interventions based on their attributes. Results: The Spanish health policy-makers, managers and other stakeholder displayed a stronger preference for severity of disease, high individual benefits, a large number of beneficiaries and proven cost-effectiveness criteria in decision making. The priority interventions targeted severe mental disorders, i.e. major depressive disorders and suicides (or suicidal attempts), especially for young and middle age categories across the three regions under study. Conclusion: In times of economic crisis, health policy-makers, managers and other stakeholder value, in moderation, efficiency over equity. The impact of austerity measures on populations’ socio-economic wellbeing seems correlated with the preference for mental health interventions.

Discrete choice experiment, MCDA, Mental health, Policy-makers, Priority setting, Spain
2211-8837
30-41
Mentzakis, Emmanouil
c0922185-18c7-49c2-a659-8ee6d89b5d74
García-Goñi, Manuel
9a0c4235-d845-44cc-b7f5-e9cccf567f17
Sequeira, Ana Rita
9b531622-b57d-4c72-a3c7-36dcc845f02c
Paolucci, Francesco
073b630d-7adc-41ee-b198-6b33bcacce6c
Mentzakis, Emmanouil
c0922185-18c7-49c2-a659-8ee6d89b5d74
García-Goñi, Manuel
9a0c4235-d845-44cc-b7f5-e9cccf567f17
Sequeira, Ana Rita
9b531622-b57d-4c72-a3c7-36dcc845f02c
Paolucci, Francesco
073b630d-7adc-41ee-b198-6b33bcacce6c

Mentzakis, Emmanouil, García-Goñi, Manuel, Sequeira, Ana Rita and Paolucci, Francesco (2019) Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders preferences. Health Policy and Technology, 8 (1), 30-41. (doi:10.1016/j.hlpt.2019.01.003).

Record type: Article

Abstract

Background: The trade-off between efficiency and equity has been largely studied in the health economics literature and for countries with different types of health systems. Even if efficiency and equity are desired, it is not always feasible to attain both simultaneously. In Spain, the National Health System has historically been recognized for its universal access and free of charge provision, with good health outcomes. However, the recent increase in health expenditures together with the economic cycle has turned the orientation of health policy implementation towards efficiency, threatening universality and equity in the access to healthcare. Methods: A Discrete Choice Experiment was carried out to weigh priorities of policy-makers from different regions in Spain. A total of 69 valid questionnaires were collected and the preferences towards equity and/or efficiency criteria were evaluated. Composite League Tables (CLTs) were used to rank hypothetical health interventions based on their attributes. Results: The Spanish health policy-makers, managers and other stakeholder displayed a stronger preference for severity of disease, high individual benefits, a large number of beneficiaries and proven cost-effectiveness criteria in decision making. The priority interventions targeted severe mental disorders, i.e. major depressive disorders and suicides (or suicidal attempts), especially for young and middle age categories across the three regions under study. Conclusion: In times of economic crisis, health policy-makers, managers and other stakeholder value, in moderation, efficiency over equity. The impact of austerity measures on populations’ socio-economic wellbeing seems correlated with the preference for mental health interventions.

Text
MCDA Spain - Accepted Manuscript
Restricted to Repository staff only until 6 February 2020.
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More information

Accepted/In Press date: 18 January 2019
e-pub ahead of print date: 6 February 2019
Published date: March 2019
Keywords: Discrete choice experiment, MCDA, Mental health, Policy-makers, Priority setting, Spain

Identifiers

Local EPrints ID: 429477
URI: https://eprints.soton.ac.uk/id/eprint/429477
ISSN: 2211-8837
PURE UUID: 1cc9adc7-fd23-4350-8ced-d8843acc5495
ORCID for Emmanouil Mentzakis: ORCID iD orcid.org/0000-0003-1761-209X

Catalogue record

Date deposited: 27 Mar 2019 17:30
Last modified: 10 Dec 2019 01:37

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Contributors

Author: Manuel García-Goñi
Author: Ana Rita Sequeira
Author: Francesco Paolucci

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