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Measuring preferences for care, health and well-being:Developing and applying methods in the Netherlands and Latin America

Karen Trujillo Jara · 8 Oct 2026

Abstract

This dissertation aims to address these identified empirical and methodological gaps by applying and refining preference elicitation methods across different domains (i.e., care, health, and well-being) and contexts (i.e., the Netherlands and several Latin American countries). Chapter 2 addresses the limited empirical evidence on how individuals evaluate and trade off combinations of public health policies under explicit system constraints by applying Participatory Value Evaluation (PVE) in the Netherlands. Chapter 3 responds to the limited and fragmented application of preference elicitation methods in Latin America and the lack of empirical evidence on policy trade-offs under constraints in this context. It reports on a PVE in Peru which elicits citizens’ preferences for school opening policies during a public health crisis, thereby providing evidence on how individuals trade off public health risks against learning outcomes and child well-being under different risk scenarios. Chapter 4 addresses the limited empirical evidence on stakeholder perspectives in care and policy decision-making, as well as the limited use of approaches that systematically identify and compare such perspectives in Latin America. It applies Q methodology to patient-centred care (PCC) in Peru, identifying viewpoints among patients and healthcare professionals regarding which dimensions of PCC should be prioritised. Chapter 5 examines the monetary valuation of health and broader well-being outcomes. It reports on a study estimating societal WTP for both health gains (QALYs) and well-being gains (WALYs). Hence, it provides empirical estimates in a context where such evidence remains scarce and informs the absolute and relative valuation of broader outcomes within health economic evaluation. Chapter 6 investigates methodological issues related to the anchoring of wellbeing scales and the placement of “dead” by analysing how individuals position dead relative to ICECAP-A well-being states. This exploratory study aims to stimulate the discussion on the importance of anchoring in valuing well-being states, which is crucial for the interpretation and use of WALY calculations in economic evaluations. Chapter 7 addresses methodological and empirical gaps related to the contextual validity of multidimensional well-being measures in Latin America by validating the recently developed 10-item Well-being instrument (WiX) in Argentina, Chile, Ecuador, and Peru. In doing so, this chapter provides evidence on its content and construct validity and its applicability for use in these settings. Finally, Chapter 8 discusses the overall findings of the thesis, reflects on its strengths and limitations, and outlines research and policy implications, and concludes. The overall scope and structure of the dissertation are illustrated in Figure 1.1.