Preferences Over Equity in the Allocation of Health Care Resources
Posted: 14 Jun 2007
Date Written: June 2007
The equitable allocation of health care resources is a central goal in many health systems. Scholars from economics, political science, philosophy, ethics and other areas have offered many alternative conceptions of an equitable, or just, allocation of health care resources. In their seminal work, Yaari and Bar-Hillel (1984) were among the first to investigate people's preferences over alternative equity notions when allocating a fixed supply of resources. Our work builds on this tradition of using stated preference experiments to elicit individual preferences for equitable allocations of resources. We elicit preferences for the equitable allocation of two types of goods, a non-heatlh care good (apples) that can produce health effects and a health care good (pain relief pills). For a specific allocation problem we examine preferences over the following allocation principles: utilitarianism, maximin, relative need, equal split. Our study extends the existing literature in the following ways. It compares preferences under three information sets: (1) only information defining each principle; (2) only information on the quantitative allocations associated with each principle (but no information on which principle each allocation is associated with); (3) information on both the principles and the associated allocations. We compare preferences for the allocation of a non-health care health-affecting good and heatlh care. We include a qualitative component that explores the reasoning individuals used in selecting their referred equity principle. The survey was conducted in Hamilton, ON and includes both a university-based sample of students and staff as well as a community-based sample drawn from the city of Hamilton. We find that the most commonly selected principle is allocation according to relative need, but that the distribution of choices differs importantly depending on the information set available; we do not find statistical differences between the non-health care and health care goods; the qualitative component revealed that particpants generally understood the exercise and could articulate clear reasons for their choices, but that the underlying reasoing processes differed even among those making identical choices.
Keywords: Resource allocation, priority setting, equity
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