Public preferences to trade-off gains in total health for health equality

Discrepancies between an abstract scenario versus the real-world scenario presented by Covid-19

Bibliographic Data

ID5722283
AuthorsDavid A Comerford (0000-0003-2611-9504, University of Stirling, corresponding author), Angela Tufte-Hewett (Birmingham City University), Angela Tufte‐Hewett (Birmingham City University), Emma K Bridger (0000-0002-4726-4068, University of Leicester)
Year2024
Volume36
Issue1
Pages66-92
Publication date2024-02-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueRationality and Society (JOURNAL)
Journal identifiersISSN: 1043-4631 • E-ISSN: 1461-7358
PublisherSAGE Publications Inc (PUBLISHER)
DOI10.1177/10434631231193599
OpenAlexW4385647671
LanguageEN
Citations received2
References cited40

Policymakers must ration healthcare. This necessity became salient during the COVID-19 pandemic. Some policymakers took that opportunity to reduce inequality of health outcomes at the expense of overall health gains. There is a literature that seeks to quantify the optimal trade-off between efficiency and equality in health outcomes: economists employ surveys to quantify the public's preferred level of equity/efficiency trade-off. An odd result from these studies is that a non-trivial subsample of respondents choose to "level down" i.e., they choose as though an additional year of life delivers negative utility to society if it accrues to the most privileged. In an experiment of US and UK respondents ( n = 495), we compare equity/efficiency trade-offs across an abstract scenario along the lines of that presented in previous surveys versus a COVID-19 scenario, where it is made explicit that healthcare rationing is a real and current necessity occasioned by the pandemic. We find that preference for "levelling down" is reduced in the COVID-19 scenario relative to the abstract scenario. This result implies that, at least in the context of the COVID-19 pandemic, previous results have overestimated the public's willingness to sacrifice overall gains in population health in order to reduce inequality of health outcomes

Actuarial science · Demographic economics · Economic growth · Economics · Geography · Health care · Health equity · Inequality · Pandemic · Political science · Population · Population health · Public economics · Public health · Rationing · Sociology · Demography · Global Health Care Issues · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Mathematics · Medicine

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