People’s preferences of public health services differ based on region, income and educational attainment

The ambulance chased one patient into collections

A study conducted in the UPV/EHU’s Department of Public Policy and Economic History reveals that people’s preferences with respect to public health services differ between regions, and recommends devolving decisions and management of public healthcare policies to regional governments.

In any healthcare system, knowing what patients’ preferences are is essential in policy-making and investment decisions regarding health care services. In other words, it is about making decisions on how to structure healthcare services according to citizens’ preferences in a way that maximizes the well-being of the population. One way of finding out these preferences is to quantify how citizens value public health services in terms of money, ie how much are they willing to pay for improvements in the health services offered in public health care?

This study, conducted by the UPV/EHU’s Department of Public Policy and Economic History, set out to identify the preferences of citizens in the Basque Country and the Canary Islands regarding possible improvements in public health services; in other words, to identify the willingness of citizens to pay for improvements in the public health service.”

Waleska Sigüenza and Alaitz Artabe, researchers and authors of the study

To identify these preferences, the choice experiment method was used. “It consists of presenting the interviewee with various sets of alternatives for improvements in health services characterized by different combinations of these improvements, and asking him/her to choose the preferred alternative from each set,” explained the authors of the study. “The improvements analyzed in this work were: waiting lists for specialists, waiting lists for surgical operations, hospital comfort, public health care and dental coverage,” added the authors.


On the one hand, the results indicate that preferences differ between regions, so for reasons of efficiency, it would be advisable to devolve decisions and the management of public healthcare policies to regional governments, so that different decisions can be made according to the preferences of each region.

On the other hand, however, there are also differences between the preferences of citizens in the same region. For example, “we saw that in the Basque Country high- and low-income individuals do not value health services in the same way. We saw that the higher the income of a person in the Basque Country is, the lower their willingness is to pay for improvements in some of the aspects of public healthcare analysed. This result may be related to the preferences that high-income Basques have for private health services”, said the authors. However, “we saw that in the Canary Islands the level of educational attainment exerts an influence: citizens with a university education are willing to pay more to improve their public health services”, added Waleska Sigüenza and Alaitz Artabe.

Once health policies are decentralized, the results of this work provide a tool to identify the health services most valued by individuals in each region. With all due caution, these results show not only the order of healthcare preferences, but also the value of these preferences in terms of money. This information could be useful for people in charge of designing healthcare policies when allocating economic resources to maximize the overall well-being of the region.


Journal reference:

Sigüenza, W & Artabe, A., (2022) Do individuals’ health preferences validate the decentralization of the public health system in Spain?. Health Policy.



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