Involving the public in priority setting: a case study using discrete choice experiments

BACKGROUND: Health-care organizations need to prioritize their resource use and should incorporate the public's preferences into their priority setting process. METHODS: We apply a discrete choice experiment (DCE) to obtain weights, from the public, for use in a priority setting exercise. Ten attributes were chosen: location of care, public consultation, use of technology, service availability, patient involvement, management of care, evidence of effectiveness, health gain, risk avoidance and priority area. From the DCE responses, weighted benefit scores were calculated and used to rank development bids from across a health-care organization. RESULTS: Sixty-eight members of the public completed the DCE. All attributes except risk avoidance were significant. The most important attribute levels were a large health gain to many people: care being provided in teams, using latest or cutting-edge technology and 24 h service availability. Local priorities were valued higher than national priorities. Ninety-five bids were ranked in order of overall score. The ranked list of development bids provided a useful tool to inform prioritization decisions. CONCLUSIONS: DCEs can offer a theoretically valid and practical means of incorporating the views of the public in an accessible, transparent and streamlined decision-making process when health-care organizations are prioritizing their resources.