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Social values and their role in allocating resources for new health technologies Open Access


Other title
health technologies
resource allocation
deliberative processes
social values
public involvement
citizens' juries
Type of item
Degree grantor
University of Alberta
Author or creator
Stafinski, Tania
Supervisor and department
Devidas Menon, School of Public Health
Examining committee member and department
L. Duncan Saunders, Department of Public Health Sciences
Raisa Deber, Faculty of Medicine, University of Toronto
Donald Philippon, School of Public Health
Tim Caulfield, Faculty of Law
Yutaka Yasui, Department of Public Health Sciences
Deborah Marshall, Faculty of Medicine, University of Calgary
Medical Sciences - Public Health Sciences

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Every healthcare system faces unlimited demands and limited resources, creating a need to make decisions that may limit access to some new, potentially effective technologies. It has become increasingly clearer that such decisions are more than technical ones. They require social value judgements - statements of the public’s distributive preferences for healthcare across the population. However, these value judgements largely remain ill-defined. The purpose of this thesis was to explicate distributive preferences of the public to inform funding/coverage decisions on new health technologies. It contains six papers. The first comprises a systematic review of current coverage processes around the world, including value assumptions embedded within them. The second paper presents findings from an expert workshop and key-informant interviews with senior-level healthcare decision-makers in Canada. A technology funding decision-making framework, informed by the results of the first paper and the experiences of these decision-makers, was developed. Their input also highlighted the lack of and need for information on values that reflect those of the Canadian public. The third paper provides a systematic review of empirical studies attempting to explicate distributive preferences of the public. It also includes an analysis of social value arguments found in appeals to negative coverage decisions. From the results of both components, possible approaches to eliciting social values from the public and a list of factors around which distributive preferences may be sought were compiled. Such factors represented characteristics of unique, competing patient populations. Building on findings from the third paper, the fourth paper describes a citizens’ jury held to explicate distributive preferences for new health technologies in Alberta, Canada. The jury involved a broadly representative sample of the public, who participated in decision simulation exercises involving trade-offs between patient populations characterized by different combinations of factors. A list of preference statements, demonstrating interactions among such factors, emerged. The fifth and sixth papers address methodological issues related to citizens’ juries, including the comparability of findings from those carried out in the same way but with different samples of the public, and the extent to which they changed the views of individuals who participate in them.
License granted by Tania Stafinski ( on 2010-09-23T21:50:04Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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