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

Comerford, David and Tufte-Hewett, Angela and Bridger, Emma K. (2023) 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. Rationality & Society. ISSN 1043-4631

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Abstract

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.

Item Type:	Article
Identification Number:	10.1177/10434631231193599
Dates:	Date Event 24 July 2023 Accepted 7 August 2023 Published Online
Uncontrolled Keywords:	Distributional cost‐effectiveness analysis, empirical ethics, empirical social choice, health inequality, inequality aversion
Subjects:	CAH04 - psychology > CAH04-01 - psychology > CAH04-01-01 - psychology (non-specific) CAH15 - social sciences > CAH15-02 - economics > CAH15-02-01 - economics
Divisions:	Faculty of Business, Law and Social Sciences > College of Psychology
Depositing User:	Angela Hewett
Date Deposited:	10 Aug 2023 10:35
Last Modified:	11 Jun 2024 13:02
URI:	https://www.open-access.bcu.ac.uk/id/eprint/14668

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