A Qualitative Study of the Views of Health and Social Care Decision-makers on the Role of Wellbeing in Resource Allocation Decisions in the UK

Tessa Peasgood,John Brazier,Jill Carlton

doi:10.3390/economies7010014

Tessa Peasgood, John Brazier + Show 1 more

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https://doi.org/10.3390/economies7010014

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Journal: Economies	Publication Date: Feb 22, 2019
Citations: 6	License type: CC BY 4.0

Affiliation: University of Sheffield

Abstract

There has been growing international interest in the role that wellbeing measures could play within policy making in health and social care. This project explored the opinions of a sample of UK decision-makers on the relevance of wellbeing and subjective wellbeing (by which we mean good and bad feelings or overall evaluations of life, such as life satisfaction) for resource allocation decisions within health and social care. Through these discussions we draw out the perceived advantages and the potential concerns that decision-makers have about broadening out to wellbeing and subjective wellbeing rather than just measuring health. Three focus groups were conducted: with members of the National Institute for Health and Care Excellence (NICE) Citizen’s Council, with a Health and Wellbeing Board at a Local Authority and with Public Health England. In addition, eleven semi-structured interviews were held with staff from NHS England and members of a range of NICE committees. We identified a range of opinions about the role of wellbeing and a broadly held view that there was a need for improved consideration of broader quality of life outcomes. We also identified considerable caution in relation to the use of subjective wellbeing.

Highlights

Economic evaluation of healthcare commonly estimates the incremental cost per Quality AdjustedLife Year (QALY) of new health technologies
A number of themes emerged from the analysis around the definitions of wellbeing, conflicting opinions on the role of wellbeing within resource allocation decisions for public policy, concerns around the use of subjective wellbeing whilst simultaneously recognising its importance
Some participants stated that measuring wellbeing was central for individual and population level resource allocation decisions, seeing it as the ultimate outcome of interest and arguing that it was important to look “at people as a whole” (NICE CC)

Summary

Introduction

Economic evaluation of healthcare commonly estimates the incremental cost per Quality AdjustedLife Year (QALY) of new health technologies. QALYs provide a way to capture both survival- and health-related quality of life (HRQoL) benefits. Whilst HRQoL may include all aspects of quality of life that could theoretically be impacted by health or health care, the term is often used to identify the subset of important ways in which health or health care impacts upon quality of life (Torrance 1987; Brazier et al 2017). The rationale for taking a narrower perspective reflects the interests of healthcare policy-makers and clinicians and facilitates sensitive measurement of those aspects of quality of life most likely to change following treatment. A potential solution to cross-sector comparability is to rely on a broader quality of life or wellbeing measure (Brazier and Tsuchiya 2015). We can distinguish between a number of different theoretical conceptions of wellbeing (see Peasgood et al 2014), but here we use the term wellbeing in its broadest sense without aligning to any particular theory of wellbeing

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