Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 17, Issue 2, 2014. Pages: 61-73
Published Online: 1 June 2014

Priority Setting in the Austrian Healthcare System: Results from a Discrete Choice Experiment and Implications for Mental Health

Emmanouil Mentzakis,¹* Francesco Paolucci,² Georg Rubicko³

¹Economics Department, School of Social Sciences, University of Southampton, UK
²Faculty of Health and Life Sciences, University of Northumbria Newcastle, UK
³Independent Researcher, Vienna, Austria

* Correspondence to: Emmanouil Mentzakis, Economics Department, University of Southampton, University Rd., Southampton, SO17 1BJ, UK.
Tel.: +44-23-8059 7247
E-mail: E.Mentzakis@soton.ac.uk

Source of Funding: None declared.

Abstract

With changing health needs, policy makers have to balance constrained resources and increasing demands. Preference-based approaches offer complementary information for priority setting decisions and a useful tool to support decision-making. Preferences over efficiency and equity and an empirical measure of their trade-off are calculated using a discrete choice experiment on stakeholders in Austria. Subsequently, health care interventions, including mental health, are ranked in composite league tables. Findings suggest a strong preference for criteria of efficiency; with equity parameters (with the exception of severity of condition) reducing utility from a given intervention. Efficiency/equity ratios are calculated at 3.5 and 5 for interventions targeted at younger and middle age populations, respectively, while for older populations this ratio is negative implying a rejection of all equity criteria. Irrespective of such differences interventions targeting mental health rank highly on all CLTs.

Background: The impact of mental conditions is expected to be among the highest ranked causes of illness in high income countries by 2020. With changing health needs, policy makers have to make choices in an environment with increasingly constrained resources and competing demands. Discrete choice experiments have been identified as a useful approach to inform and support decision-making in health care systems and, in particular, its rationing.

Methods: Policymakers, researchers and health practitioners from Austria participated in an experiment designed to elicit preferences for efficiency and equity in a generic priority setting framework. Using aggregate criteria an empirical measure of the efficiency/equity trade-off is calculated and a selection of health care interventions, including mental health, are ranked in composite league tables (CLTs).

Results: With the exception of severity of the condition, all equity parameters decrease attractiveness of an intervention, whereas the opposite holds for all three efficiency criteria. The efficiency/equity ratio (i.e. decision-makers' preference for efficiency over equity) is 3.5 and 5 for interventions targeted at younger and middle age populations, respectively, while for older populations this ratio is negative implying a rejection of all equity criteria. Irrespective of such differences interventions targeting mental health rank highly on all CLTs.

Conclusion: Based on system-wide generic decision making criteria, mental health is shown to be a top priority for Austria. Preference-based approaches might offer complementary information to policymakers in priority setting decisions and a useful tool to support rationale rather than ad hoc decision-making.

Received 12 February 2013; accepted 12 April 2014