Priority setting in the Spanish health system

In most countries, priority setting of health interventions is often ad hoc or based on heuristic approaches and political motives, resulting in the exclusion of important information. In a context of competing demands and constrained health resources, it becomes apparent that more rational and transparent approaches are needed. Spain is not an exception. Within an environment of continuously increasing health care needs and costs, the recent economic crisis threatens the sustainability of the Spanish National Health System. The economic and health consequences of the crisis urge the implementation of effective and rational policies in the long-run. This thesis elaborates the impact of equity and efficiency criteria on Spanish stakeholders’ preferences. A discrete choice experiment is employed among policy makers, health managers and researchers from different regions in Spain and the relative importance of these attributes is established. Using aggregate equity and efficiency attributes, an empirical measure of the equity/efficiency trade-offs is calculated. The results of the experiment are used in order to rank health interventions based on their equity and efficiency characteristics. Mental disorders among other disease areas are extensively analysed, given the increasing burden of mental illness in all high-income countries. The results of the DCE indicate that preferences among equity and efficiency criteria vary among regions and some trade-offs indeed take place. DCEs have already been identified as a useful approach to inform and rationalise priority setting processes. This thesis shows that multi-criteria decision analysis (MCDA) can be a valuable tool in supporting rational prioritisation decisions and incorporate aggregate equity and efficiency preferences in Spain.