Public views on principles for health care priority setting: findings of a European cross-country study using Q methodology

Job van Exel*, Rachel Baker, Helen Mason, Cam Donaldson, Werner Brouwer, EuroVaQ Team

*Corresponding author for this work

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Resources available to the health care sector are finite and typically insufficient to fulfil all the demands for health care in the population. Decisions must be made about which treatments to provide. Relatively little is known about the views of the general public regarding the principles that should guide such
decisions. We present the findings of a Q methodology study designed to elicit the shared views in the general public across ten countries regarding the appropriate principles for prioritising health care resources. In 2010, 294 respondents rank ordered a set of cards and the results of these were subject to by-person factor analysis to identify common patterns in sorting. Five distinct viewpoints were identified, (I) “Egalitarianism, entitlement and equality of access”; (II) “Severity and the magnitude of health gains”; (III) “Fair innings, young people and maximising health benefits”; (IV) “The intrinsic value of life and
healthy living”; (V) “Quality of life is more important than simply staying alive”.
Given the plurality of views on the principles for health care priority setting, no single equity principle can be used to underpin health care priority setting. Hence, the process of decision making becomes more important, in which, arguably, these multiple perspectives in society should be somehow reflected.
Original languageEnglish
Pages (from-to)128-137
Number of pages10
JournalSocial Science and Medicine
Early online date22 Dec 2014
Publication statusPublished - Feb 2015


  • Europe
  • resource allocation
  • decision making
  • health care
  • social values
  • Q methodology
  • QALYs
  • equity

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