Public preferences for allocating health system resources in Canada: a systematic review

Background Conventional economic evaluations are based on the principle of health maximization. However, this approach does not consider societal preferences to prioritize health care for certain social groups and health conditions, and the public concern over health disparities. In recent years, equity-sensitive economic evaluation methods have been developed to incorporate societal concern over for health inequities. These methods use quantitative evidence based on preference elicitation exercises to inform allocation of health system resources. Objective To systematically review Canadian studies that quantify public preferences for allocating health care resource across sociodemographic groups and health conditions Methods Three electronic databases were searched: Ovid Embase, Ovid MEDLINE, and EBSCO EconLit. In addition, the reference lists of relevant papers were also scanned to detect any other suitable studies. The systematic review included studies meeting two criteria: studies that sampled Canadians and those where participants made decisions about resource allocation or responded to hypothetical scenarios about redistributing lifetime health. Two reviewers conducted screening, full-text review, and data extraction. Results Eight studies were identified that investigated public preferences for prioritizing health care in relation to age, income, disease rarity and baseline health. Age-related preferences favored children and younger patients over older patients. Aversion to socioeconomic-related health inequality was heterogeneous and was associated with respondent characteristics. No clear preference was found for treatments for rare diseases over common conditions, or for baseline quality of life and life expectancy. Two studies exposed participants to moral reasoning exercises that resulted in slightly lower level of prioritization of specific conditions or groups. Conclusion There is clear evidence to prioritize health care resources for children and younger patients over older patients. There is limited or no Canadian evidence on societal values on tackling health inequity related to socioeconomic status, sex/gender, race/ethnicity and other social determinants of health. Future research can help bridge this gap.