Seminarios

Introduction: This study aims to assess preferences and values for priority setting in national healthcare in Chile. Growing recognition of the importance of priority setting for healthcare as an ethical concern and as a way to allocate limited resources to meet population’s health needs has motivated this study.

Method: Based on the answers from a first survey that look into the main barriers the Chilean population face, this study considers the preferences of the communities to prioritize overcoming those barriers. The information for this study was collected using a population sample survey. This survey incorporated six programs that will allow the state to overcome the barriers previously identified. The programs included: (1) investing in new infrastructure, (2) providing better healthcare coverage, (3) increasing physicians/specialists, (4) adding new informatics systems, (5) promoting new awareness healthcare programs, and (6) financing additional drugs. People were asked to prioritize each of these programs; firstly by their opinion and secondly by allocating resources.

A second part in the survey asked people´s preferences for a distributive justice principle for healthcare to guide priority setting of services in Chile. They are: 1) equal access for healthcare, 2) equal access for equal health needs, 3) equal access for equal ability to benefit, and 4) equality in health. Four steps were followed: (1) selecting a representative sample for three regions in Chile, (2) piloting in a small-scale and revise the instrument, (3) administering the survey, and (4) analyzing the data using STATA 13.

Results: The survey was conducted with a total of 1,142 sample individuals. More than half of the interviewees (56.4%) indicated a single program as their first priority, while 20.1% selected two of them as their first priority.

To increase the number of doctors/specialists in the country to improve patient-doctor communication was the program that obtained the highest priority, with 34,7% of answers. The second and third priorities correspond to improving and investing in infrastructure (16.5%) and expanding the coverage of healthcare insurances (15.7%).

Additionally, the results showed that equal access for equal healthcare is the principle selected by the majority of participants to guide distributed justice. 

Discussion and conclusions: This study shade lights on how a large sample of individuals in a country can participate in major decision making of national health policies, other than the more popular methods of discrete choice experiment or citizens’ jury.  Despite the complexity of the questions asked, this study demonstrated that with adequate guidance, average population is capable of engaging in expressing their preferences and values in such decision making. Further, 95.1% of the participants in this study indicated that they would like to be asked by the Ministry of Health about their opinion on the main policy changes of the health system. The results suggest that most national health systems can involve their citizens to participate in the normative part of priority setting in health system. Results of this study provide policy-makers useful community generated information for prioritizing policies to improve access to healthcare.