Are pricing and reimbursement decision-making criteria aligned with public preferences regarding allocation principles in the Polish healthcare sector?

Abstract

Given growing interest in multicriteria decision making and multiple cost–effectiveness thresholds’ approach, it was decided to investigate its usefulness in Poland. The pricing and reimbursement (P&R) regulations were reviewed and a cross-sectional survey was conducted amongst nurses. The study investigated whether P&R rules are aligned with the preferences of healthcare professional towards the concept of equity. The references to aversion to inequalities in health and capacity to benefit were recognized as the most and least important principle respectively by the group of nurses. Different weightings of health gain dependent on disease severity were accepted by half of the study’s population. In the review of legal acts, references to capacity to benefit were frequently found. The opposite was registered for other concepts of equity. There is room for further improvement with respect to the alignment between the Polish P&R decision making criteria and public preferences regarding allocation principles.

Keywords::

• Central Europe
• cost effectiveness
• equity
• multi criteria decision making
• pricing and reimbursement

Acknowledgements

The study leader would like to thank organization ‘Inny Format’ for the support with the recruitment of study participants.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The search for optimal allocation of health care resources requires decision-making criteria to be established first. The effectiveness and equity are most common. While the first implies health maximization, the latter introduces resource distribution according to disease severity, aversion to health inequalities or capacity to benefit.

• Choice of allocation criteria has to be pursued through the study of social preferences. Public involvement in the development of allocation principles is a democratic right, and it gives health authorities a mandate to make responsible decisions on behalf of society.

• A review of the Polish legal acts and health technology assessment reports showed that capacity to benefit is the most frequently reviewed aspect in the pricing and reimbursement processes regarding both drug and non-drug technologies. At the same time, the study of social preferences indicates that aversion to health inequities and disease severity received more public attention than capacity to benefit.

• There is room for further improvement of the alignment between the Polish pricing and reimbursement decision-making criteria and public preferences regarding allocation principles.

• There are a number of methodological approaches such as multicriteria decision-making and multiple cost–effectiveness thresholds which allow several conflictive criteria to be taken into consideration in pricing and reimbursement decision-making processes in an explicit manner.