Background and objectives

Additional funding will be needed to meet the growing demand for health and social care in the UK. What is the most acceptable way to raise it? Options range from taxation to mandatory insurance, voluntary insurance and user charges. We sought to analyse the preferences of the UK general public.

Methods

An online quantitative survey embedded within a DCE was undertaken with a representative sample of 2,756 members of the public in England, Northern Ireland, Scotland and Wales, recruited from a survey panel. The DCE was designed on the basis of detailed background research including focus groups and cognitive interviews. The survey also collected information on respondents', age, health state, experience of health and social care, income, employment status and education; and tested respondents’ knowledge and awareness of National Health Service (NHS) and social care funding levels and sources. From the DCE data we developed models to understand the influence that differences in attributes had on the propensity to choose funding mechanisms.

Results

From the scaled MNL model results, all sections of the public – across age groups, income groups, employment status, health status and countries of the UK – would like additional funding for adult social care to be raised in the same way as additional NHS funding. Specifically, the public prefer a collective rather than individualistic approach to raising additional funds; and preferably a progressive system. All age groups prefer that contributions should not differ by age per se. Raising additional funds should for preference be by a public, not a private, organisation. There is support for earmarking the funds raised to only be used for health care or social care. Preferences are very similar across the four UK countries, once age and socioeconomic characteristics are controlled for.

Conclusions

This research provides novel evidence to help policy makers understand the relative public acceptability of different options for raising additional funds for health and adult social care in the UK. We find uniformity of preferences across the UK countries and across sub-groups of the population.

中文翻译：

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衡量公共卫生和社会护理资金选择之间的偏好

背景和目标

英国将需要额外的资金来满足对健康和社会护理不断增长的需求。筹集资金的最可接受的方法是什么？选择范围从税收到强制保险，自愿保险和用户费用。我们试图分析英国公众的偏好。

方法

在DCE中进行了在线定量调查，从调查小组中招募了2756名英格兰，北爱尔兰，苏格兰和威尔士的公众代表性样本。DCE是在详细的背景研究（包括焦点小组和认知访谈）的基础上设计的。调查还收集了有关受访者的年龄，健康状况，健康和社会护理经验，收入，就业状况和教育程度的信息；并测试了受访者对国家卫生服务（NHS）以及社会护理资金水平和来源的了解和认识。从DCE数据中，我们开发了模型以了解属性差异对选择融资机制的倾向的影响。

结果

从扩展的MNL模型结果中，所有年龄段，收入群体，就业状况，健康状况和英国国家/地区的公众都希望以与额外的NHS资金相同的方式筹集用于成人社会护理的额外资金。具体而言，公众更倾向于集体而非个人主义的方式来筹集更多资金；最好是渐进式系统。所有年龄段的人都希望捐款的年龄本身不应该有所不同。筹集更多资金应该优先由公共组织而非私人组织进行。支持将募集的资金专用于医疗或社会护理。一旦控制了年龄和社会经济特征，英国四个国家的偏好就非常相似。

结论

这项研究提供了新颖的证据，可以帮助决策者了解公众对于英国为健康和成人社会护理筹集更多资金的各种选择的相对接受程度。我们发现英国各个国家和不同人群的偏好具有统一性。