People’s preferences for public health services differ by region, income and level of education


A study conducted within the Department of Public Policy and Economic History of the UPV/EHU reveals that people’s preferences for public health services differ from one region to another and recommends delegating decisions and the management of public health policies to regional governments.

In any health system, knowing patient preferences is essential in policy-making and investment decisions about health care services. In other words, it is about making decisions on how to structure health services according to the preferences of citizens in such a way as to maximize the well-being of the population. One way to find out about these preferences is to quantify the monetary value of public health services, i.e. how much are they willing to pay for improved health services offered under public health care?

This study, carried out by the Department of Public Policy and Economic History of the UPV/EHU, aimed to identify the preferences of citizens of the Basque Country and the Canary Islands regarding possible improvements in public health services; in other words, to identify citizens’ willingness to pay for improvements in the public health service.”

Waleska Sigüenza and Alaitz Artabe, researchers and authors of the study

To identify these preferences, the choice experiment method was used. “It consists of presenting the respondent with different sets of health service improvement alternatives characterized by different combinations of these improvements, and asking them to choose the preferred alternative from each set”, explain the authors of the study. study. “The improvements analyzed in this work were: waiting lists for specialists, waiting lists for surgical operations, hospital comfort, public health and dental coverage”, add the authors.

On the one hand, the results indicate that preferences differ between regions, so for reasons of efficiency, it would be desirable to delegate decisions and management of public health policies to regional governments, so that different decisions can be taken according to the preferences of each region.

On the other hand, however, there are also differences between the preferences of citizens of the same region. For example, “we have seen that in the Basque Country individuals with high and low incomes do not place the same value on health services. We have seen that the higher the income of a person in the Basque Country, the less they have to pay for improvements in some of the aspects of public health analyzed. This result may be related to the preferences of high-income Basques for private health services,” the authors said. However, “we have seen that in the Canary Islands, the level of education exerts an influence: citizens with a university education are ready to pay more to improve their public health services”, added Waleska Sigüenza and Alaitz Artabe.

Once health policies are decentralized, the results of this work provide a tool to identify the health services most valued by individuals in each region. With all due caution, these results not only show the order of health care preferences, but also the value of those preferences in terms of money. This information could be useful to those responsible for designing health policies when allocating economic resources to maximize the overall well-being of the region.


Journal reference:

Sigüenza, W & Artabe, A., (2022) Do individuals’ health preferences validate the decentralization of the public health system in Spain?. Health policy.


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