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Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey

OBJECTIVE: Preferences of members of the public are recognized as important inputs into health care priority-setting, though knowledge of such preferences is scant. We sought to generate evidence of public preferences related to healthcare resource allocation among adults and children. METHODS: We c...

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Autores principales: Denburg, Avram E., Ungar, Wendy J., Chen, Shiyi, Hurley, Jeremiah, Abelson, Julia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier B.V. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219374/
https://www.ncbi.nlm.nih.gov/pubmed/32405121
http://dx.doi.org/10.1016/j.healthpol.2020.04.007
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author Denburg, Avram E.
Ungar, Wendy J.
Chen, Shiyi
Hurley, Jeremiah
Abelson, Julia
author_facet Denburg, Avram E.
Ungar, Wendy J.
Chen, Shiyi
Hurley, Jeremiah
Abelson, Julia
author_sort Denburg, Avram E.
collection PubMed
description OBJECTIVE: Preferences of members of the public are recognized as important inputs into health care priority-setting, though knowledge of such preferences is scant. We sought to generate evidence of public preferences related to healthcare resource allocation among adults and children. METHODS: We conducted an experimental stated preference survey in a national sample of Canadian adults. Preferences were elicited across a range of scenarios and scored on a visual analogue scale. Intervention group participants were randomized to a moral reasoning exercise prior to each choice task. The main outcomes were the differences in mean preference scores by group, scenario, and demographics. RESULTS: Our results demonstrate a consistent preference by participants to allocate scarce health system resources to children. Exposure to the moral reasoning exercise weakened but did not eliminate this preference. Younger respondent age and parenthood were associated with greater preference for children. The top principles guiding participants’ allocative decisions were treat equally, relieve suffering, and rescue those at risk of dying. CONCLUSIONS: Our study affirms the relevance of age in public preferences for the allocation of scarce health care resources, demonstrating a significant preference by participants to allocate healthcare resources to children. However, this preference diminishes when challenged by exposure to a range of moral principles, revealing a strong public endorsement of equality of access. Definitions of value in healthcare based on clinical benefit and cost-effectiveness may exclude moral considerations that the public values, such as equality and humanitarianism, highlighting opportunities to enrich healthcare priority-setting through public engagement.
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spelling pubmed-72193742020-05-13 Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey Denburg, Avram E. Ungar, Wendy J. Chen, Shiyi Hurley, Jeremiah Abelson, Julia Health Policy Article OBJECTIVE: Preferences of members of the public are recognized as important inputs into health care priority-setting, though knowledge of such preferences is scant. We sought to generate evidence of public preferences related to healthcare resource allocation among adults and children. METHODS: We conducted an experimental stated preference survey in a national sample of Canadian adults. Preferences were elicited across a range of scenarios and scored on a visual analogue scale. Intervention group participants were randomized to a moral reasoning exercise prior to each choice task. The main outcomes were the differences in mean preference scores by group, scenario, and demographics. RESULTS: Our results demonstrate a consistent preference by participants to allocate scarce health system resources to children. Exposure to the moral reasoning exercise weakened but did not eliminate this preference. Younger respondent age and parenthood were associated with greater preference for children. The top principles guiding participants’ allocative decisions were treat equally, relieve suffering, and rescue those at risk of dying. CONCLUSIONS: Our study affirms the relevance of age in public preferences for the allocation of scarce health care resources, demonstrating a significant preference by participants to allocate healthcare resources to children. However, this preference diminishes when challenged by exposure to a range of moral principles, revealing a strong public endorsement of equality of access. Definitions of value in healthcare based on clinical benefit and cost-effectiveness may exclude moral considerations that the public values, such as equality and humanitarianism, highlighting opportunities to enrich healthcare priority-setting through public engagement. Elsevier B.V. 2020-06 2020-05-13 /pmc/articles/PMC7219374/ /pubmed/32405121 http://dx.doi.org/10.1016/j.healthpol.2020.04.007 Text en © 2020 Elsevier B.V. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Denburg, Avram E.
Ungar, Wendy J.
Chen, Shiyi
Hurley, Jeremiah
Abelson, Julia
Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey
title Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey
title_full Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey
title_fullStr Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey
title_full_unstemmed Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey
title_short Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey
title_sort does moral reasoning influence public values for health care priority setting?: a population-based randomized stated preference survey
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219374/
https://www.ncbi.nlm.nih.gov/pubmed/32405121
http://dx.doi.org/10.1016/j.healthpol.2020.04.007
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