Examining the Association between Polish Migrant Status and Health Preferences Using a Novel Application of a Smaller Design EQ-5D-5L Valuation Study

Abstract

Introduction Migrants have different utilisation of healthcare services and health-related behaviours than host populations. A potential factor that may contribute to the notable differences in healthcare use and health-related behaviours between migrants and host populations is how these groups value health. Those who place a high value on health have greater healthcare-seeking practices than those who do not. Objective The aim of this study was to examine how Polish migrants and native Irish differ in health state utility valuations using a novel application of a smaller design EQ-5D-5L valuation study. Methods This study uses health preferences as a predictor of how one values health. We examined the EQ-5D-5L health preferences of 119 Polish migrants and 123 native Irish, both residing full-time in Ireland. To do so, we used a novel application of a smaller design EQ-5D-5L valuation study that consisted of 30 health states and a targeted sampling strategy coupled with a Bayesian statistical nonparametric model. We collected data from June 2018 to September 2019. Results Our results highlight that Polish migrants and native Irish differ in their health preferences for and valuation of severe health states. Polish migrants place meaningfully higher utility valuations of 0.1 or more on the three most severe health states compared with the native Irish. Conclusion This study can provide an understanding of a potential new factor underpinning some of the disparities in healthcare utilisation and health-related behaviours among migrants and host populations in Europe. This study also provides proof of principle for using a smaller design EQ-5D-5L valuation study to explore differences in health preferences among other minority subgroups, which can otherwise be hard to uncover when using the secondary analysis of national EQ-5D-5L valuation studies.

Use of a Non-parametric Bayesian Method to Model Health State Preferences: An Application to Polish and Irish EQ-5D-5L Valuations

“…First, the study sample size was small which may in some sense limit the generalizability of the utility values obtained. Second, snowball sampling has been used, thus a good representative sample of Polish migrants and/or native Irish was not selected, let alone there was some difficulties associated with obtaining a good representative sample [see Kelleher et al ( 33 ) for an overview]. This implies that the results of this study ought not to be considered as good representative of Polish migrants and/or native Irish in Ireland.…”

“…These studies require a minimum of 1,000 respondents to value 86 health states, as mentioned above. As such, using the methods employed in this paper and a similar smaller design EQ-5D-5L valuation study to Kelleher et al (33), future national valuation studies could be conducted more efficiently by having less respondents to value less health states compared to current large-scale national valuation studies. Examining this could be particularly promising and would form a key research agenda for further research.…”

“…Since they represent the largest non-Irish community residing in Ireland, the Polish migrants were chosen to be included in this valuation study. Detailed description of the survey design and sampling strategy has been reported elsewhere ( 33 ). In brief, a sample of 240 (120 Polish migrants and 120 native Irish) respondents was recruited to value six practice states each in addition to one block of 11 cTTO states.…”

“…Using the blocking algorithm that is readily available in the “AlgDesign” package in the software package R, the 30 EQ-5D-5L health states were split up into three blocks of 11 health states. The rationale for this is to make sure that within-block variance is maximized, thereby observations on the full health–dead scale are attained [see Kelleher et al ( 33 ) for an overview].…”

“…More detailed explanation on the extended experimental design, survey design and sampling strategy is provided in Kelleher et al ( 33 ).…”