The impact of race and lifestyle-dependent exposures on health state preferences and the implication for health system utilization

Societal preferences for health are used to inform health resource allocation models in the development of standards of care. Surveys, such as the EuroQol 5D (EQ-5D) and Medical Expenditures Panel Survey (MEPS), are used to elicit population responses regarding health function domains and facilitate the calculation of health utilities for allocation strategies. Accurate assessment of the data obtained through these surveys is important to serve as valid and reliable tools for guiding policy decisions within a constrained budgetary environment. As survey data is collected individuals and aggregated to inform the stakeholders, understanding the effects that social and healthcare exposures have on choice made by populations and the potential impact on health disparities is critical to an efficient allocation framework.;The 2002 EQ-5D national survey contained data that showed race as a significant predictor of hypothetical health state valuation. This study examines whether utilization of healthcare is associated with health valuations; and the role social circumstances have in valuation results. We first examined relationships between race and health valuation (n= 19,016 adults; Whites (60.17%), Blacks (14.86%) and Hispanics (24.87%)) in the 2003 MEPS to determine if healthcare expenditures were associated with individual self- perception. Health valuation was measured by visual analog scale (VAS) of current health (0-100) and preference-based indexes, computed according to the formula in Dolan (1997) ranging from (-0.59 to 1) using five health domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Adjusting for demographic and chronic health-related factors, respondents defining their current health as low (VAS: 0- 79) had incremental annual expenditures of ;Subsequent analyses were conducted on responses elicited through valuation activities in the 2002 AHRQ-funded EQ-5D survey. Each individual participating in the survey was asked to evaluate multiple health hypothetical health states, leading to a total of 49,554 responses. The survey oversampled minorities and our analysis of the data confirmed race differences in the valuation of health. Assessing hypothetical health states, Blacks had lower odds (odds ratio [OR] = 0.677) of valuing indexed health states as problematic [<1]. Alternatively, when assessing own health using the VAS, Blacks had greater odds (OR = 1.327) of valuing current health as low. However, no mediating relationship was determined when examining whether SES, individual health experience, household structure, religious beliefs and behavioral risk-factors impacted the race-valuation relationship (Base model OR: 0.677, Full Model OR: 0.641). While it is unknown whether alternate social circumstances mediate health valuations, healthcare strategists should examine the race-valuation relationship further to better forecast intervention effects on expenditures and valued-use of services.