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Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism

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  • Aki Tsuchiya

    (School of Health and Related Research, Department of Economics, University of Sheffield, Sheffield, UK)

  • Paul Dolan

    (Tanaka Business School, Imperial College, University of London, London, UK)

Abstract

When deciding how to weigh benefits to different groups, standard economic models assume that people focus on the final distribution of utility, health or whatever. Thus, an egalitarian is assumed to be an egalitarian in the outcome space. But what about egalitarianism in the gains space, such that people focus instead on how equally benefits are distributed? This paper reports on a study in which members of the public were asked to rank a number of health programmes that differed in the distribution of benefits and final outcomes in ways that enabled us to distinguish between different types of egalitarianism. The results suggest that outcome egalitarianism dominates, particularly for differences in health by social class, but a sizeable minority of respondents appear to be gain egalitarians, especially when the health differences are by sex. These results have important implications for how we think about outcome-based social welfare functions in economics. Copyright © 2008 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1355
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 18 (2009)
Issue (Month): 2 ()
Pages: 147-159

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Handle: RePEc:wly:hlthec:v:18:y:2009:i:2:p:147-159

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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  1. Aki Tsuchiya & Luis Silva Miguel & Richard Edlin & Allan Wailoo & Paul Dolan, 2005. "Procedural Justice in Public Healthcare Resource Allocation," Applied Health Economics and Health Policy, Springer Healthcare | Adis, vol. 4(2), pages 119-127.
  2. Wailoo, Allan & Anand, Paul, 2005. "The nature of procedural preferences for health-care rationing decisions," Social Science & Medicine, Elsevier, vol. 60(2), pages 223-236, January.
  3. Abasolo, Ignacio & Tsuchiya, Aki, 2004. "Exploring social welfare functions and violation of monotonicity: an example from inequalities in health," Journal of Health Economics, Elsevier, vol. 23(2), pages 313-329, March.
  4. Dolan, Paul & Tsuchiya, Aki, 2005. "Health priorities and public preferences: the relative importance of past health experience and future health prospects," Journal of Health Economics, Elsevier, vol. 24(4), pages 703-714, July.
  5. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
  6. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
  7. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the 'Fair Innings' Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132.
  8. Dolan, Paul & Olsen, Jan Abel, 2002. "Distributing Health Care: Economic and ethical issues," OUP Catalogue, Oxford University Press, number 9780192632531.
  9. Dolan, Paul & Olsen, Jan Abel, 2001. "Equity in health: the importance of different health streams," Journal of Health Economics, Elsevier, vol. 20(5), pages 823-834, September.
  10. Tsuchiya, Aki & Williams, Alan, 2005. "A "fair innings" between the sexes: are men being treated inequitably?," Social Science & Medicine, Elsevier, vol. 60(2), pages 277-286, January.
  11. Samuelson, William & Zeckhauser, Richard, 1988. " Status Quo Bias in Decision Making," Journal of Risk and Uncertainty, Springer, vol. 1(1), pages 7-59, March.
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Cited by:
  1. Richardson, Jeff & Sinha, Kompal & Iezzi, Angelo & Maxwell, Aimee, 2012. "Maximising health versus sharing: Measuring preferences for the allocation of the health budget," Social Science & Medicine, Elsevier, vol. 75(8), pages 1351-1361.
  2. Richard Norman & Gisselle Gallego, 2008. "Equity weights for economic evaluation: An Australian Discrete Choice Experiment, CHERE Working Paper 2008/5," Working Papers 2008/5, CHERE, University of Technology, Sydney.
  3. Neil Buckley & Katherine Cuff & Jeremiah Hurley & Logan McLeod & Robert Nuscheler & David Cameron, 2010. "Willingness-to-Pay for Parallel Private Health Insurance: Evidence from Laboratory Experiment," Centre for Health Economics and Policy Analysis Working Paper Series 2010-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  4. Tania Stafinski & Devidas Menon & Deborah Marshall & Timothy Caulfield, 2011. "Societal Values in the Allocation of Healthcare Resources," The Patient: Patient-Centered Outcomes Research, Springer, vol. 4(4), pages 207-225, December.
  5. Marlies Ahlert & Katja Funke & Lars Schwettmann, 2013. "Thresholds, productivity, and context: an experimental study on determinants of distributive behaviour," Social Choice and Welfare, Springer, vol. 40(4), pages 957-984, April.

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