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Qualitative methodologies in health-care priority setting research

Listed author(s):
  • Neale Smith

    (Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada)

  • Craig Mitton

    (Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada)

  • Stuart Peacock

    (Centre for Health Economics in Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada)

Registered author(s):

    Priority setting research in health economics has traditionally employed quantitative methodologies and been informed by post-positivist philosophical assumptions about the world and the nature of knowledge. These approaches have been rewarded with well-developed and validated tools. However, it is now commonly noted that there has been limited uptake of economic analysis into actual priority setting and resource allocation decisions made by health-care systems. There seem to be substantial organizational and political barriers. The authors argue in this paper that understanding and addressing these barriers will depend upon the application of qualitative research methodologies. Some efforts in this direction have been attempted; however these are theoretically under-developed and seldom rooted in any of the established qualitative research traditions. Two such approaches - narrative inquiry and discourse analysis - are highlighted here. These are illustrated with examples drawn from a real-world priority setting study. The examples demonstrate how such conceptually powerful qualitative traditions produce distinctive findings that offer unique insight into organizational contexts and decision-maker behavior. We argue that such investigations offer untapped benefits for the study of organizational priority setting and thus should be pursued more frequently by the health economics research community. Copyright © 2008 John Wiley & Sons, Ltd.

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    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 18 (2009)
    Issue (Month): 10 ()
    Pages: 1163-1175

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    Handle: RePEc:wly:hlthec:v:18:y:2009:i:10:p:1163-1175
    DOI: 10.1002/hec.1419
    Contact details of provider: Web page:

    References listed on IDEAS
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    1. Richard D. Smith, 2007. "The relationship between reliability and size of willingness‐to‐pay values: a qualitative insight," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 211-216, 02.
    2. Rachel Baker & Angela Robinson, 2004. "Responses to standard gambles: are preferences 'well constructed'?," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 37-48.
    3. Martin, Douglas K. & Hollenberg, Daniel & MacRae, Sue & Madden, Shannon & Singer, Peter, 2003. "Priority setting in a hospital drug formulary: a qualitative case study and evaluation," Health Policy, Elsevier, vol. 66(3), pages 295-303, December.
    4. Madden, Shannon & Martin, Douglas K. & Downey, Sarah & Singer, Peter A., 2005. "Hospital priority setting with an appeals process: a qualitative case study and evaluation," Health Policy, Elsevier, vol. 73(1), pages 10-20, July.
    5. Wagner, Todd H. & Hu, Teh-wei & Duenas, Grace V. & Pasick, Rena J., 2000. "Willingness to pay for mammography: item development and testing among five ethnic groups," Health Policy, Elsevier, vol. 53(2), pages 105-121, September.
    6. Joanna Coast, 1999. "The appropriate uses of qualitative methods in health economics," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 345-353.
    7. Eddama, Oya & Coast, Joanna, 2008. "A systematic review of the use of economic evaluation in local decision-making," Health Policy, Elsevier, vol. 86(2-3), pages 129-141, May.
    8. Patten, San & Mitton, Craig & Donaldson, Cam, 2006. "Using participatory action research to build a priority setting process in a Canadian Regional Health Authority," Social Science & Medicine, Elsevier, vol. 63(5), pages 1121-1134, September.
    9. Williams, Iestyn & Bryan, Stirling, 2007. "Understanding the limited impact of economic evaluation in health care resource allocation: A conceptual framework," Health Policy, Elsevier, vol. 80(1), pages 135-143, January.
    10. Bate, Angela & Donaldson, Cam & Murtagh, Madeleine J., 2007. "Managing to manage healthcare resources in the English NHS? What can health economics teach? What can health economics learn?," Health Policy, Elsevier, vol. 84(2-3), pages 249-261, December.
    11. Michael Drummond, 2004. "Economic Evaluation in Health Care: Is It Really Useful or Are We Just Kidding Ourselves?," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 37(1), pages 3-11, 03.
    12. Stirling Bryan & Iestyn Williams & Shirley McIver, 2007. "Seeing the NICE side of cost‐effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 179-193, 02.
    13. Mitton, Craig & Patten, San & Waldner, Howard & Donaldson, Cam, 2003. "Priority setting in health authorities: a novel approach to a historical activity," Social Science & Medicine, Elsevier, vol. 57(9), pages 1653-1663, November.
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