Are all health gains equally important? An exploration of acceptable health as a reference point in health care priority setting

Abstract

BackgroundAccumulating evidence suggests that members of society prefer some QALY gains over others. In this paper, we explore the notion of acceptable health as a reference point in assessing the value of health gains. The value of health benefits may be assessed in terms of their position relative to this reference level, benefits above the level of acceptable health being valued differently from benefits below this level. In this paper we focus on assessing the level of acceptable health at different ages and associations with background variables.MethodsWe recruited a sample of the adult population from the Netherlands (n = 1067) to investigate which level of health problems they consider to be acceptable for people aged 40 to 90, using 10-year intervals. We constructed acceptable health curves and associated acceptable health with background characteristics using linear regressions.ResultsThe results of this study indicate that the level of health problems considered acceptable increases with age. This level was associated with respondents’ age, age of death of next of kin, health and health behaviour.ConclusionsOur results suggest that people are capable of indicating acceptable levels of health at different ages, implying that a reference point of acceptable health may exist. While more investigation into the measurement of acceptable health remains necessary, future studies may also focus on how health gains may be valued relative to this reference level. Gains below the reference point may receive higher weight than those above this level since the former improve unacceptable health states while the latter improve acceptable health states.

The Corrective Approach: Policy Implications of Recent Developments in QALY Measurement Based on Prospect Theory

“…Furthermore, research has also documented that age-dependent expectations about length and quality of life could also serve as reference point. [50][51][52] Collectively, these findings indicate that if a similar approach is to be developed as for time preference, more research on reference points in decisions about health is required. Nonetheless, in Appendix II, we provide a first suggestion as to how insights from loss aversion may be included in economic evaluations, by incorporating a loss aversion premium.…”

A short note on measuring subjective life expectancy: survival probabilities versus point estimates

“…The data presented here were collected in the context of a larger study investigating expectations about longevity and quality of life at older age [15], acceptability of less than perfect health states [16], and health state valuations [17]. …”

Determinants of the acceptability of health problems in different ages: exploring a new application of the EQ VAS

“…Instead of being concerned with inequalities, sufficientarianists propose that it is morally important for everyone to have just enough [ 6 ]. It has been shown in empirical studies on the Dutch general population [ 7 , 8 ] and a sample of Hungarian patients with rheumatoid arthritis (RA) [ 9 ] that people have internal reference points, against which they compare the acceptability of certain health states via a simple acceptable—not acceptable judgement. The reference points depend on age, suggesting that more health problems are acceptable in older ages [ 7 – 9 ].…”

“…However, rendering a binary acceptable/not acceptable status to all 243 discrete health states across several age-groups poses a feasibility challenge for the comprehensive evaluation of AHSs. To overcome these challenges, previous studies investigated AHSs in different ages separately by each dimension of the EQ-5D-3L [ 7 – 9 ]. These studies left uncertainty about the acceptability of simultaneous health problems in more than one dimension.…”