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As a complement to assessments of safety, efficacy and economic efficiency, decision-makers seeking to allocate healthcare resources increasingly demand information on the values, preferences, ethical principles and beliefs of the constituencies they serve. In Canada, values-based decision-making and public engagement in the priority-setting process were recently identified as national priority areas for research. 1 In the UK, both the National Institute for Health and Clinical Excellence (NICE) and the National Health Service (NHS) now view the values of the British public as vital to fulfilment of their democratic mandates. 2 3
But what is the best way to identify the public's values? This paper introduces a novel technique to investigate social values, evaluates its performance via a randomised experiment and assesses its potential contribution to strengthening values-based decision-making and public engagement. We evaluate our technique by exploring people's attitudes toward the role of patient age in healthcare resource allocation. This topic was chosen because it has been researched extensively in the scientific literature 4 - 12 and by NICE, 2 13 which has assumed a leadership role in exploring social value judgments related to priority setting. 2 We first motivate the enquiry with a brief review of current methods and findings.
Large-scale surveys have been widely used to explore social value judgements such as the role of age in healthcare priority setting. Despite their ability to elicit information from a large cross-section of the public rapidly and at relatively low cost, these approaches suffer from at least four important shortcomings. (1) People may require time to form a considered judgement on an issue, while such surveys prompt responses based on initial reactions with little time to reflect. 14 15 (2) Some responses to public surveys may reflect prejudices unsuitable for embodiment in public policy. For example, there is evidence of widespread age-based prejudice in society 16 and in medical practice. 17 - 20 (3) Responses can be shaped inappropriately by subjective factors and framing effects. 12 14 21 22 (4) The perspective of survey designers may also unintentionally skew results. Large-scale surveys have found extensive evidence of public preferences favouring allocation to younger age groups 6 - 12 but health economists may systematically have neglected dimensions where preferences for age-based priority setting are neutral...