Working Papers 2014

1/2014  Teresa C. Rodrigues, Mónica D. Oliveira, Carlos A. Bana e Costa, Paula Santana, "The MACBETH approach to health value measurement: a multicriteria model for building a value-based population health index"

Health indexes have been used to evaluate population health in its multiple dimensions, providing valuable information to drive health related policies and the planning of health services. Nevertheless, health indexes reported in the literature have often lacked theoretical foundations and incurred in drawbacks. Aiming to contribute to this literature, this study proposes (and applies) a framework that combines concepts from multicriteria value measurement with participatory methods to build a value-based population health index. From the technical side, the MACBETH approach was used to construct the population health index within a hierarchical multicriteria model structure, with the model having two main areas of concern – health determinants and outcomes – that are specified by a set of evaluation criteria in which several dimensions of the health of a population are appraised. From the social side, the application of MACBETH was supported by a combination of participatory methods including a modified Delphi process with a large group of health stakeholders and experts, and decision conferences with a strategic group. The proposed framework was applied to build an index to evaluate population health at the municipality level in Portugal over the past twenty years (within the scope of the GeoHealthS research project). The index generates a wide set of outputs within a ‘’tableau-de-bord’’ structure which will integrate a Geographic Information System and will be the starting point for policy makers and planners analysing variations in population health and geographical health inequalities in the Portuguese territory and to evaluate the impact of health and health equity oriented policies.