Efficiency and equity considerations in the preferences of health policy-makers in Israel

Amir Shmueli,Ofra Golan,Francesco Paolucci,Emmanouil Mentzakis

doi:10.1186/s13584-017-0142-7

Abstract

BackgroundThere is a traditional tension in public policy between the maximization of welfare from given resources (efficiency) and considerations related to the distribution of welfare among the population and to social justice (equity). The aim of this paper is to measure the relative weights of the efficiency- and equity-enhancing criteria in the preferences of health policy-makers in Israel, and to compare the Israeli results with those of other countries.MethodsWe used the criteria of efficiency and equity which were adopted in a previous international study, adapted to Israel. The equity criteria, as defined in the international study, are: severity of the disease, age (young vs. elderly), and the extent to which the poor are subsidized. Efficiency is represented by the criteria: the potential number of beneficiaries, the extent of the health benefits to the patient, and the results of economic assessments (cost per QALY gained). We contacted 147 policy-makers, 65 of whom completed the survey (a response rate of 44%). Using Discrete Choice Experiment (DCE) methodology by 1000Minds software, we estimated the relative weights of these seven criteria, and predicted the desirability of technologies characterized by profiles of the criteria.ResultsThe overall weight attached to the four efficiency criteria was 46% and that of the three equity criteria was 54%. The most important criteria were “financing of the technology is required so that the poor will be able to receive it” and the level of individual benefit. “The technology is intended to be used by the elderly” criterion appeared as the least important, taking the seventh place. Policy-makers who had experience as members of the Basket Committee appear to prefer efficiency criteria more than those who had never participated in the Basket Committee deliberations. While the efficiency consideration gained preference in most countries studied, Israel is unique in its balance between the weights attached to equity and efficiency considerations by health policy-makers.DiscussionThe study explored the trade-off between efficiency and equity considerations in the preferences of health policy-makers in Israel. The way these declarative preferences have been expressed in actual policy decisions remains to be explored.

Highlights

There is a traditional tension in public policy between the maximization of welfare from given resources and considerations related to the distribution of welfare among the population and to social justice
The objective of this study is to analyze the relative importance of efficiency and equity considerations in the preferences of the health policy-makers in Israel at the declarative level, and to compare the Israeli results with the results obtained in the international study
The fifth criterion is “cost per Quality Adjusted Life Years (QALYs)” which is the most significant efficiency criterion, and the sixth is the criterion “the technology is intended for patients suffering from a serious disease”, an equity criterion

Summary

Introduction

There is a traditional tension in public policy between the maximization of welfare from given resources (efficiency) and considerations related to the distribution of welfare among the population and to social justice (equity). The aim of this paper is to measure the relative weights of the efficiency- and equityenhancing criteria in the preferences of health policy-makers in Israel, and to compare the Israeli results with those of other countries. There is a traditional and long-standing tension in economics between efficiency - defined as the maximization of welfare - and equity, which includes considerations of equality, the distribution of welfare and social justice. When health is measured as Quality Adjusted Life Years (QALYs), as is the case in economic assessments of health technologies, efficiency is identified with the maximization of QALYs. maximization of health itself does not take into account considerations of equality, justice, medical need, etc. Alan Williams, the eminent British health economist, stated: ‘Health systems typically pursue two broad objectives: to maximize the health of the population served, and to reduce inequalities in health...there is conflict between achievement of these two objectives, so that – in setting policy – an explicit weight should be given to each’ ([3], p. 64)

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