Sailing without radar: an excursion in resource allocation

Public views on priority setting for high cost medications in public hospitals in Australia

OBJECTIVE

To gather information about views of members of the general public about access to High Cost Medications (HCMs) in public hospitals.

METHODS

A structured questionnaire was administered to members of the general public. Individuals were approached in train stations, shopping centres and different venues in the Sydney metropolitan area. People were eligible to answer the survey if they were: over 18 years of age, Australian permanent residents and able to complete the questionnaire in English.

RESULTS

Two hundred people completed the survey. Of these 56% were females, 47% were married, 84% spoke English at home, 88% were working either full-time or part-time, 61% had a university degree, 27% had a household annual income greater than 100,000 dollars and 68% had private health insurance. Participants considered factors such as treatment outcomes, quality of life and current health status when determining who should have access to HCMs. Participants wanted resources to be allocated to provide the 'greatest benefit to the greatest number of people'. Almost half the respondents did not want direct involvement in decision-making, however, 38% did.

CONCLUSIONS

The results offered support for indirect involvement through the development of a process to involve community members in discussion on policy on the provision of treatment and services within health-care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals.

The use of conjoint analysis to elicit community preferences in public health research: a case study of hospital services in South Australia

AIMS

To demonstrate the use of conjoint analysis (CA) in public health research through a survey of the South Australian community about aspects of their public hospital services.

METHODS

A series of focus groups determined the most important attributes in choice of hospital services. These were built into a CA survey, using the discrete choice approach. The survey was posted to a representative sample of 700 South Australians. Theoretical validity, internal consistency and non-response bias were all investigated.

RESULTS

Some 231 individuals returned the questionnaire. The attribute, 'improvement in complication rates' was positively associated with choice of hospital. Three attributes were found to be negatively associated with such choice: 'waiting times for casualty', 'waiting times for elective surgery' and, anomalously, 'parking and transport facilities'. 'Travel time' and the cost attribute, 'Medicare levy' were not statistically significant. Trade-offs between the significant attributes were estimated, as were satisfaction or utility scores for different ways of providing hospital services. Results concerning internal consistency and internal validity were encouraging, but some potential for non-response bias was detected.

CONCLUSION

A high premium is placed on the quality of hospital care and members of the community are prepared to choose between hospitals largely on the basis of outcomes and length of waiting times for elective surgery and in casualty.

IMPLICATIONS

CA can yield potentially policy-relevant information about community preferences for health services.