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Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall

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  • E. Wetering
  • E. Stolk
  • N. Exel
  • W. Brouwer

Abstract

Economic evaluations are increasingly used to inform decisions regarding the allocation of scarce health care resources. To systematically incorporate societal preferences into these evaluations, quality-adjusted life year gains could be weighted according to some equity principle, the most suitable of which is a matter of frequent debate. While many countries still struggle with equity concerns for priority setting in health care, the Netherlands has reached a broad consensus to use the concept of proportional shortfall. Our study evaluates the concept and its support in the Dutch health care context. We discuss arguments in the Netherlands for using proportional shortfall and difficulties in transitioning from principle to practice. In doing so, we address universal issues leading to a systematic consideration of equity concerns for priority setting in health care. The article thus has relevance to all countries struggling with the formalization of equity concerns for priority setting. Copyright The Author(s) 2013

Suggested Citation

  • E. Wetering & E. Stolk & N. Exel & W. Brouwer, 2013. "Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 107-115, February.
    • Handle: RePEc:spr:eujhec:v:14:y:2013:i:1:p:107-115
    DOI: 10.1007/s10198-011-0346-7
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    1. Shah, Koonal K. & Tsuchiya, Aki & Wailoo, Allan J., 2015. "Valuing health at the end of life: A stated preference discrete choice experiment," Social Science & Medicine, Elsevier, vol. 124(C), pages 48-56.
    2. van Exel, Job & Baker, Rachel & Mason, Helen & Donaldson, Cam & Brouwer, Werner, 2015. "Public views on principles for health care priority setting: Findings of a European cross-country study using Q methodology," Social Science & Medicine, Elsevier, vol. 126(C), pages 128-137.
    3. Arthur E. Attema & Werner B. F. Brouwer & Jose Luis Pinto‐Prades, 2022. "Reference‐dependent age weighting of quality‐adjusted life years," Health Economics, John Wiley & Sons, Ltd., vol. 31(12), pages 2515-2536, December.
    4. Reckers-Droog, V.T. & van Exel, N.J.A. & Brouwer, W.B.F., 2018. "Looking back and moving forward: On the application of proportional shortfall in healthcare priority setting in the Netherlands," Health Policy, Elsevier, vol. 122(6), pages 621-629.
    5. Juan Oliva-Moreno, 2023. "Response letter for the comment made on our article entitled “Does the inclusion of societal costs change the economic evaluations recommendations? A systematic review for multiple sclerosis disease”,," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(4), pages 663-672, June.
    6. Ottersen, Trygve & Førde, Reidun & Kakad, Meetali & Kjellevold, Alice & Melberg, Hans Olav & Moen, Atle & Ringard, Ånen & Norheim, Ole Frithjof, 2016. "A new proposal for priority setting in Norway: Open and fair," Health Policy, Elsevier, vol. 120(3), pages 246-251.
    7. Saeed Shahabi & Shahina Pardhan & Ahmad Ahmadi Teymourlouy & Dimitrios Skempes & Shabnam Shahali & Parviz Mojgani & Maryam Jalali & Kamran Bagheri Lankarani, 2021. "Prioritizing solutions to incorporate Prosthetics and Orthotics services into Iranian health benefits package: Using an analytic hierarchy process," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-13, June.
    8. Nord, Erik & Johansen, Rune, 2014. "Concerns for severity in priority setting in health care: A review of trade-off data in preference studies and implications for societal willingness to pay for a QALY," Health Policy, Elsevier, vol. 116(2), pages 281-288.
    9. Herlitz, Anders & Horan, David, 2016. "Measuring needs for priority setting in healthcare planning and policy," Social Science & Medicine, Elsevier, vol. 157(C), pages 96-102.
    10. Erik Nord, 2018. "Beyond QALYs: Multi-criteria based estimation of maximum willingness to pay for health technologies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 267-275, March.
    11. E. Wetering & N. Exel & J. Rose & R. Hoefman & W. Brouwer, 2016. "Are some QALYs more equal than others?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(2), pages 117-127, March.
    12. Øystein Ariansen Haaland & Frode Lindemark & Kjell Arne Johansson, 2019. "A flexible formula for incorporating distributive concerns into cost-effectiveness analyses: Priority weights," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-12, October.
    13. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
    14. World Bank, 2015. "Bulgaria Health Financing," World Bank Publications - Reports 22964, The World Bank Group.
    15. Franken, Margreet & Stolk, Elly & Scharringhausen, Tessa & de Boer, Anthonius & Koopmanschap, Marc, 2015. "A comparative study of the role of disease severity in drug reimbursement decision making in four European countries," Health Policy, Elsevier, vol. 119(2), pages 195-202.
    16. Reckers-Droog, Vivian & Jansen, Maarten & Bijlmakers, Leon & Baltussen, Rob & Brouwer, Werner & van Exel, Job, 2020. "How does participating in a deliberative citizens panel on healthcare priority setting influence the views of participants?," Health Policy, Elsevier, vol. 124(2), pages 143-151.
    17. Jeff Richardson & Angelo Iezzi & Aimee Maxwell & Gang Chen, 2018. "Does the use of the proportional shortfall help align the prioritisation of health services with public preferences?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 797-806, July.
    18. Mitchell, Paul Mark & Roberts, Tracy E. & Barton, Pelham M. & Coast, Joanna, 2015. "Assessing sufficient capability: A new approach to economic evaluation," Social Science & Medicine, Elsevier, vol. 139(C), pages 71-79.
    19. Erik Nord & Rune Johansen, 2015. "Transforming EQ-5D utilities for use in cost–value analysis of health programs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 313-328, April.
    20. Nord, Erik, 2012. "Measuring concerns for severity: Re-examination of a health scale with purported equal interval properties," Health Policy, Elsevier, vol. 105(2), pages 312-316.
    21. Wouters, S. & van Exel, N.J.A. & Rohde, K.I.M. & Vromen, J.J. & Brouwer, W.B.F., 2017. "Acceptable health and priority weighting: Discussing a reference-level approach using sufficientarian reasoning," Social Science & Medicine, Elsevier, vol. 181(C), pages 158-167.

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    More about this item

    Keywords

    Proportional shortfall; Priority setting; Equity; Social value; Resource allocation; I10; I18;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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