| Summary: | Most governments in the world provide some publicly funded healthcare to their citizens, but given the scarcity of resources relative to potential demand, some form of rationing or priority setting is required, and some patients must be denied effective treatment. The thesis took the position that an explicit approach based on maximising the value that society derives from healthcare is the preferred way to address this rationing problem. Conventional health economic practice proposes that value should be equated with quality-adjusted life years (QALYs), leading to a policy of QALY maximisation, but, it is argued, not necessarily value maximisation. A more inclusive approach to defining value, based on societal preferences, may maximise overall well-being and be associated with greater trust and legitimacy in the priority setting process. The thesis identified patient and program characteristics that appeared to have empirical evidence of public support as well as a defensible ethical justification in determining the strength of a patient’s claim to societal healthcare resources. The relative strength of preferences for these characteristics, or the equity-efficiency trade-off, was estimated using stated preference methods. Two different methods, discrete choice experiments and constant-sum paired comparisons, were used and the response behaviours of the two elicitations were compared to identify a preferred method for eliciting societal preferences in the context of healthcare. Both methods found a statistically significant equity-efficiency trade-off in an age and sex representative sample of the Canadian public as well as a convenience sample of decision-making agents. This suggested that society would be willing to sacrifice some degree of efficiency in maximising individual life year gains in order to prioritise other characteristics consistent with the promotion of equity or distributive justice in the allocation of healthcare resources. However, differences between the results of the two elicitation methods suggested some systematic procedural variance.
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