Shifting Priorities in Healthcare Resource Allocation: A Repeat Study in Flemish-speaking Belgium

Background

When prioritizing healthcare resources, decision-makers must weigh logistical and moral factors. In their Discrete Choice Experiment (DCE), Luyten et al (2015) demonstrated that the general population placed high value on moral considerations – particularly the influence of a patient’s lifestyle on their disease (prioritizing healthier lifestyles) and the age at which they acquired it (prioritizing the young) – over other factors. Since then, the COVID-19 pandemic presented a highly moralized healthcare crisis.

Methods

In 2025, we replicated the DCE by Luyten et al (2015), cross-sectionally surveying a representative sample of 811 adults in Flanders, Belgium. We investigated multinomial and mixed logistic regression models to evaluate a main-effects model, replicate the 2015 model, and test additional attribute interactions. Attribute importance was assessed using likelihood ratio tests and preference heterogeneity was examined through interaction terms.

Results

All attributes — patient lifestyle and age; illness severity and duration; and intervention type, effectiveness, and adverse effects— remained statistically significant contributors to the social value of a healthcare program. The importance of effectiveness increased substantially compared to the original study, making it a leading attribute with age and lifestyle. The role of other attributes such as severity of illness also increased, resulting in a more balanced distribution of attribute importance, with inter-respondent heterogeneity based on age and health status.

Conclusions

This move from predominantly moral considerations to a more balanced perspective suggests evidence of a shift in how Belgians weigh healthcare priorities post COVID-19. Such preferences may reflect broader societal shifts influenced by a pandemic shaped by scarcity, vulnerability, and the imperative of effective solutions, and can inform multi-criteria objective functions for healthcare resource allocation policy.

Key messages

• This 2025 study replicated a seminal 2015 Discrete Choice Experiment, showing modest post-COVID shifts in the healthcare prioritization preferences of Flemish-speaking Belgians.

• Moral factors still matter, but effectiveness now rivals age and lifestyle as a top driver of allocation preferences, which can inform multi-criteria healthcare resource allocation policy.