Measuring public preferences between health and social care funding options

Abstract

Background and objectivesAdditional funding will be needed to meet the growing demand for health and social care in the UK. What is the most acceptable way to raise it? Options range from taxation to mandatory insurance, voluntary insurance and user charges. We sought to analyse the preferences of the UK general public. MethodsAn online quantitative survey embedded within a DCE was undertaken with a representative sample of 2,756 members of the public in England, Northern Ireland, Scotland and Wales, recruited from a survey panel. The DCE was designed on the basis of detailed background research including focus groups and cognitive interviews. The survey also collected information on respondents', age, health state, experience of health and social care, income, employment status and education; and tested respondents’ knowledge and awareness of National Health Service (NHS) and social care funding levels and sources. From the DCE data we developed models to understand the influence that differences in attributes had on the propensity to choose funding mechanisms. ResultsFrom the scaled MNL model results, all sections of the public – across age groups, income groups, employment status, health status and countries of the UK – would like additional funding for adult social care to be raised in the same way as additional NHS funding. Specifically, the public prefer a collective rather than individualistic approach to raising additional funds; and preferably a progressive system. All age groups prefer that contributions should not differ by age per se. Raising additional funds should for preference be by a public, not a private, organisation. There is support for earmarking the funds raised to only be used for health care or social care. Preferences are very similar across the four UK countries, once age and socioeconomic characteristics are controlled for. ConclusionsThis research provides novel evidence to help policy makers understand the relative public acceptability of different options for raising additional funds for health and adult social care in the UK. We find uniformity of preferences across the UK countries and across sub-groups of the population.