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The nature of procedural preferences for health-care rationing decisions

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  • Wailoo, Allan
  • Anand, Paul

Abstract

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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  • 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.
    • Handle: RePEc:eee:socmed:v:60:y:2005:i:2:p:223-236
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    1. 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.
    2. Sophie Harnay & Élisabeth Tovar, 2017. "Obeying vs. resisting unfair laws. A structural analysis of the internalization of collective preferences on redistribution using classification trees and random forests," Working Papers hal-04141635, HAL.
    3. Trani, Jean-Francois & Bakhshi, Parul & Noor, Ayan A. & Lopez, Dominique & Mashkoor, Ashraf, 2010. "Poverty, vulnerability, and provision of healthcare in Afghanistan," Social Science & Medicine, Elsevier, vol. 70(11), pages 1745-1755, June.
    4. Adam Oliver, 2005. "The English National Health Service: 1979‐2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 75-99, September.
    5. Denburg, Avram E. & Ungar, Wendy J. & Chen, Shiyi & Hurley, Jeremiah & Abelson, Julia, 2020. "Does moral reasoning influence public values for health care priority setting?: A population-based randomized stated preference survey," Health Policy, Elsevier, vol. 124(6), pages 647-658.
    6. Sophie Harnay & Elisabeth Tovar, 2017. "Obeying vs. resisting unfair laws. A structural analysis of the internalization of collective preferences on redistribution using classification trees and random forests," EconomiX Working Papers 2017-34, University of Paris Nanterre, EconomiX.
    7. Aki Tsuchiya & Paul Dolan, 2009. "Equality of what in health? Distinguishing between outcome egalitarianism and gain egalitarianism," Health Economics, John Wiley & Sons, Ltd., vol. 18(2), pages 147-159, February.

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