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The nature of procedural preferences for health-care rationing decisions

Listed author(s):
  • Wailoo, Allan
  • Anand, Paul

Substantial debate on the appropriate foundations of economic evaluation in health-care has been conducted between welfarists and non-welfarists in the health economics literature. This has focussed on defining and measuring appropriate outcomes. However, there has been little discussion of the importance of procedures. This paper examines six dimensions of procedure in relation to health-care rationing which are drawn from existing literature and previous empirical investigation. A survey of the general public was used to test for preferences for each dimension of procedure. Results show that for each dimension the importance differed according to the level of decision-making (we tested decision-making at the level of the individual doctor, health authority and government). We identified three distinct clusters of respondents who can be broadly described as "proceduralists" (47%), "pluralists" (15%) and "anti-consequentialists" (38%). The paper concludes that consequentialism is insufficient to provide the conceptual framework that public decision-making in health requires, although this does not mean that consequences are unimportant.

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Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 60 (2005)
Issue (Month): 2 (January)
Pages: 223-236

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Handle: RePEc:eee:socmed:v:60:y:2005:i:2:p:223-236
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  1. Anand, Paul, 2001. "Procedural fairness in economic and social choice: Evidence from a survey of voters," Journal of Economic Psychology, Elsevier, vol. 22(2), pages 247-270, April.
  2. Ng, Yew-Kwang, 1988. "Economic Efficiency versus Egalitarian Rights," Kyklos, Wiley Blackwell, vol. 41(2), pages 215-237.
  3. Clark, Andrew E & Oswald, Andrew J, 1994. "Unhappiness and Unemployment," Economic Journal, Royal Economic Society, vol. 104(424), pages 648-659, May.
  4. Anand, Paul, 2003. "The integration of claims to health-care: a programming approach," Journal of Health Economics, Elsevier, vol. 22(5), pages 731-745, September.
  5. Amartya Sen, 1997. "Maximization and the Act of Choice," Econometrica, Econometric Society, vol. 65(4), pages 745-780, July.
  6. Kahneman, Daniel & Knetsch, Jack L & Thaler, Richard, 1986. "Fairness as a Constraint on Profit Seeking: Entitlements in the Market," American Economic Review, American Economic Association, vol. 76(4), pages 728-741, September.
  7. Brouwer, Werner B. F. & Koopmanschap, Marc A., 2000. "On the economic foundations of CEA. Ladies and gentlemen, take your positions!," Journal of Health Economics, Elsevier, vol. 19(4), pages 439-459, July.
  8. Kotaro Suzumura, 2000. "Presidential Address: Welfare Economics Beyond Welfarist-Consequentialism," The Japanese Economic Review, Japanese Economic Association, vol. 51(1), pages 1-32, 03.
  9. Donaldson, Cam & Shackley, Phil, 1997. "Does "process utility" exist? A case study of willingness to pay for laparoscopic cholecystectomy," Social Science & Medicine, Elsevier, vol. 44(5), pages 699-707, March.
  10. Frey, Bruno S. & Pommerehne, Werner W., 1993. "On the fairness of pricing -- An empirical survey among the general population," Journal of Economic Behavior & Organization, Elsevier, vol. 20(3), pages 295-307, April.
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