Do the equity-efficiency preferences of the Israeli Basket Committee match those of Israeli health policy makers?

Background: Prioritization of medical technologies requires a multi-dimensional view. Often, conflicting equity and efficiency criteria should be reconciled. The most dramatic manifestation of such conflict is in the prioritization of new medical technologies asking for public finance performed yearly by the Israeli Basket Committee. The aim of this paper is to compare the revealed preferences of the 2006/7 Basket Committee's members with the declared preferences of health policy-makers in Israel. Methods: We compared the ranking of a sample of 18 accepted and 16 rejected technologies evaluated by the 2006/7 Basket Committee with the ranking of these technologies as predicted based on the preferences of Israeli health policy-makers. These preferences were elicited by a recent Discrete Choice Experiment (DCE) which estimated the relative weights of four equity and three efficiency criteria. The candidate technologies were characterized by these seven criteria, and their ranking was determined. A third comparative ranking of these technologies was the efficiency ranking, which is based on international data on cost per QALY gained. Results: The Committee's ranking of all technologies show no correspondence with the policy-makers' ranking. The correlation between the two is negative when only accepted technologies are ranked. The Committee's ranking is positively correlated with the efficiency ranking, while the health policy-makers' ranking is not. Discussion: The Committee appeared to assign to efficiency considerations a higher weight than assigned by health policy-makers. The main explanation is that while policy-makers' ranking is based on stated preferences, that of the Committee reflects revealed preferences. Real life prioritization, made under a budget constraint, enhances the importance of efficiency considerations at the expense of equity ones. Conclusions: In order for Israeli health policy to be consistent and well coordinated across policy-makers, some discussions and exchanges are needed, to arrive at a common set of preferences with respect to equity and efficiency considerations.