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Title: Justice, fairness and equity in health care : exploring the social value of health care interventions
Author: Green, Colin
ISNI:       0000 0001 3515 0154
Awarding Body: University of Southampton
Current Institution: University of Southampton
Date of Award: 2007
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This thesis is motivated by the need in many health care systems, but especially in the UK NHS, to make difficult choices over the use of limited resources. The starting point forthe thesis is that when making difficult choices over the provision of health care, the overall value of health care interventions to society is a function not only of the total benefits available from health care, but also the distribution of health care resources across different groups in society. The thesis investigates this proposition that 'distribution matters' and presents research to consider the social value of health care interventions. The research in the thesis is undertaken within the analytical framework of health economics, and in the context of health policy decisions over the funding of health care interventions in the UK NHS. The health technology appraisal process is used as an example of an allocation problem, and the thesis uses the UK National Institute for Health and Clinical Excellence (NICE) as an example of the health technology appraisal process. A variety of methods are usedj including an assessment of general theories of justice, a systematic review of the literature on empirical assessment of distributive preferences, an empirical study to investigate issues around the specific social value related to the severity of health condition, a discrete choice experiment (DCE) to explore a range of key social values and the relative weights placed on these social values. The research is drawn together in a policy-relevant analysis of social preferences and NHS decision-making. The thesis makes a contribution to the health economics literature and to the health policy literature. It relates general theories of justice to the process of health technology appraisal. It draws together a broad and complex literature, and characterises the literature according to the general quality of the methods used. The thesis contributes to the empirical evidence base on severity of health as an important social value. It develops a hypothesis that the empirical evidence against the importance of severity of health may be a proxy preference for giving priority to a worst off group of patients in health care priority setting; providing empirical evidence to support this hypothesis. The DCE, in a sample of the general public, finds support for using the social values around level of health improvement, value for money, severity of health, 'and the availability of other treatments, to offer an insight to the societal value of health care interventions. The level of health improvement and value for money had the greatest impact, in the discrete choice analysis, with severity of health condition also shown to have 'an important role in distributive preferences. The research contributes to the empirical evidence on the relative importance of social values in the context of difficult priority setting decisions, and it contributes to the literature on the use of the DCE framework to elicit social preferences. The thesis, extends the current evidence base by using the results from the DCE to derive a measure cif 'strength of preference' across health care interventions described using the experimental design used. The thesis demonstrates how such data may be used in a policy-relevant manner. The research in the thesis provides a greater understanding over what may be meant by equity in the allocation of health care resources, in the framework of health technology. appraisal, through consideration of equity as a balance between competing social values, amidst consideration of opportunity costs.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available