Does providing cost-effectiveness information change coverage priorities for citizens acting as social decision makers?☆

Escalating costs have generated increasing calls for Medicare to use cost-effectiveness as one criterion in determining coverage decisions. Decision-makers in U.S. health care have largely assumed that the public will reject any explicit consideration of cost in coverage policy, but there has been little formal testing of that hypothesis. We tested this assumption in a pilot study in which groups of citizens learned about and discussed health care costs, CEA methods, and common ethical issues embedded in CEA. Participants received information about 14 conditions and treatments and were asked to prioritize them for funding by Medicare under assumptions of constrained resources. Contrary to prevailing assumptions, this diverse sample understood CEA, were largely open to its use, and changed their own funding priorities when given cost-effectiveness ratio information.