The MACBETH Approach to Health Value Measurement: Building a Population Health Index in Group Processes☆

Abstract Policy-makers and planners in the health sector have been traditionally concerned with the health and health inequalities of their populations. Health indices (HIs), following population based approaches, have been used to evaluate population health in its multiple dimensions, informing health decision-makers about how variations in health determinants and outcomes result into variations in health. To enable the visualization, exploration, and modelling of geographical health patterns, HIs are used to feed Geographic Information Systems (GIS). Being important to develop formal assessment tools to evaluate population health, this study proposes a framework that combines concepts and methods from multicriteria value measurement with participatory methods to build a value-based population HI. The MACBETH approach was used to construct the population HI within a 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. 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 conferencing with a strategic group. Within the scope of the GeoHealthS research project, the proposed methods were applied to build a HI to evaluate population health at the municipality level in Portugal over the past twenty years. The underlining multicriteria model generates a wide set of outputs within a tableau-de-bord structure, to be included in a GIS and to be used for health policy analyses.