Equal access for equal need: Eliciting public preferences for access to health treatment by employment status

The National Health Service in the UK is set up under the principle of “equal access for equal need”, where those with identical medical needs should be given equal priority in receiving health care. However, non-medical needs may also be relevant in health care decision-making. This paper considers how members of the general public value access to a health service given equal medical needs, where some service users have additional non-medical needs. There are three primary research questions. First, are public preferences regarding access to a health care service symmetric and inequality averse? Second, are public preferences asymmetric across different needs groups? And third, which individual characteristics of respondents are predictive of different public preferences in this domain? An online survey of the UK general public was conducted in January 2017 using binary choice questions. The hypothetical scenarios involved allocating extra resources from a social perspective, to reduce the waiting time to access a mental health service for the unemployed, for the employed, or for both groups. Based on a valid sample of 662 respondents, the study found that the three main preference categories were: inequality averse and symmetric, inequality averse and asymmetric in favour of the unemployed, and inequality seeking and asymmetric in favour of the unemployed, with the first group being the largest. Respondents’ current labour market status was found to explain their preferences so that those who were currently job-seeking were more likely to demonstrate preferences that favoured the unemployed, and those who were currently unemployed were less likely to demonstrate asymmetric preferences that favoured the employed. The implications from these findings are that health policies in the UK that support equal access for equal medical need are likely to be received most favourably, yet a non-trivial minority may support policies favouring those with other, non-medical needs.