Acceptable health and ageing: results of a cross-sectional study from Hungary

Measuring the acceptability of EQ-5D-3L health states for different ages: a new adaptive survey methodology

BACKGROUND

Acceptable health and sufficientarianism are emerging concepts in health resource allocation. We defined acceptability as the proportion of the general population who consider a health state acceptable for a given age. Previous studies surveyed the acceptability of health problems separately per EQ-5D-3L domain, while the acceptability of health states with co-occurring problems was barely explored.

OBJECTIVE

To quantify the acceptability of 243 EQ-5D-3L health states for six ages from 30 to 80 years: 1458 health state-age combinations (HAcs), denoted as the acceptability set of EQ-5D-3L.

METHODS

In 2019, an online representative survey was conducted in the Hungarian general population. We developed a novel adaptive survey algorithm and a matching statistical measurement model. The acceptability of problems was evaluated separately per EQ-5D-3L domain, followed by joint evaluation of up to 15 HAcs. The selection of HAcs depended on respondents' previous responses. We used an empirical Bayes measurement model to estimate the full acceptability set.

RESULTS

1375 respondents (female: 50.7%) were included with mean (SD) age of 46.7 (14.6) years. We demonstrated that single problems that were acceptable separately for a given age were less acceptable when co-occurring jointly (p < 0.001). For 30 years of age, EQ-5D-3L health states of '11112' (11.9%) and '33333' (1%), while for 80 years of age '21111' (93.3%) and '33333' (7.4%) had highest and lowest acceptability (% of population), respectively.

CONCLUSION

The acceptability set of EQ-5D-3L quantifies societal preferences concerning age and disease severity. Its measurement profiles and potential role in health resource allocation needs further exploration.

Patient-centred care in Hungary: Contributions to foster a policy agenda

In Hungary, the National Health Insurance Fund provides health care coverage for nearly all residents, but healthcare spending is below the EU's average (6.4% versus 9.9% of the GDP in 2019, respectively). In 1997, patients' rights were established by laws of the healthcare system. The patients' voice, however, has remained weakly embedded in decision-making processes both on the system and individual patient levels. Policy progress achieved in the past years may foster patient-centeredness in health policy decision-making. However, people-reported data are not yet embedded in the Hungarian health information system and national population or household surveys, thus undermining the monitoring of the performance of the health system regarding patient-centred aspects. From the academic research side, several advances have occurred regarding the availability of validated instruments for the measurement of patient-centred aspects. These recent studies have placed Hungary in a uniquely advanced position compared with other countries in the Central and Eastern European (CEE) region. The use of those instruments in clinical guidelines and practices, to the education curricula of future health workers, is still in an early stage.

Comparing the measurement properties of the ICECAP-A and ICECAP-O instruments in ages 50-70: a cross-sectional study on a representative sample of the Hungarian general population

OBJECTIVE

The ICECAP-A and ICECAP-O were validated as capability wellbeing measures of adults aged 18 + and 65 + years, respectively. We aimed to compare their measurement properties in age group 50-70.

METHODS

Data were derived from a cross-sectional survey among a sample representative for the adult Hungarian population. Respondents aged between 50 and 70 filled in both the ICECAP-A and ICECAP-O questionnaires. We assessed and compared feasibility, agreement, discriminatory power, convergent and content validity of the two instruments and explored the determinants of the differences between the two measures.

RESULTS

707 respondents (99.4%) provided full answers to both questionnaires (46.3% women, average age 60.1 years). The instruments showed similar construct and convergent validity and discriminatory power. Pearson-correlations between instrument items were strong (r > 0.5). ICECAP-A and ICECAP-O scores could be calculated from each other with a good confidence (R² = 0.69 and 0.71). ICECAP-O scores (mean 0.87, SD = 0.12) were systematically higher than ICECAP-A scores (0.85, SD = 0.15) in most subgroups. The difference increased with the deterioration of capability and health, and with age. Regression results showed that employment and health status had larger marginal effect on the ICECAP-A than on the ICECAP-O scores, and these effects were larger than the effect of age on both measures.

CONCLUSION

Validity of both instruments was confirmed in the age groups 50-70. Given that employment and health status are important determinants of the differences between the two instruments besides age, the possibility of linking the choice between ICECAP-A and ICECAP-O to these factors should be investigated by further research.