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Is more health always better for society? Exploring public preferences that violate monotonicity

  • Ignacio Abásolo
  • Aki Tsuchiya


There has recently been some literature on the properties of a Health-Related Social Welfare Function (HRSWF). The aim of this article is to contribute to the analysis of the different properties of a HRSWF, paying particular attention to the monotonicity principle. For monotonicity to be fulfilled, any increase in individual health—other things equal—should result in an increase in social welfare. We elicit public preferences concerning trade-offs between the total level of health (concern for efficiency) and its distribution (concern for equality), under different hypothetical scenarios through face-to-face interviews. Of key interests are: the distinction between non-monotonic preferences and Rawlsian preferences; symmetry of HRSWF; and the extent of inequality neutral preferences. The results indicate strong support for non-monotonic preferences, over Rawlsian preferences. Furthermore, the majority of those surveyed had preferences that were consistent with a symmetric and inequality averse HRSWF. Copyright Springer Science+Business Media, LLC. 2013

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Article provided by Springer in its journal Theory and Decision.

Volume (Year): 74 (2013)
Issue (Month): 4 (April)
Pages: 539-563

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Handle: RePEc:kap:theord:v:74:y:2013:i:4:p:539-563
DOI: 10.1007/s11238-011-9292-1
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  1. Rebecca Shaw & Paul Dolan & Aki Tsuchiya & Alan Williams & Peter Smith & Roger Burrows, 2001. "Development of a questionnaire to elicit public preferences regarding health inequalities," Working Papers 040cheop, Centre for Health Economics, University of York.
  2. 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.
  3. Dutta, Indranil, 2007. "Health inequality and non-monotonicity of the health related social welfare function," Journal of Health Economics, Elsevier, vol. 26(2), pages 414-421, March.
  4. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the 'Fair Innings' Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132.
  5. Amos Tversky & Daniel Kahneman, 1991. "Loss Aversion in Riskless Choice: A Reference-Dependent Model," The Quarterly Journal of Economics, Oxford University Press, vol. 106(4), pages 1039-1061.
  6. Olsen, Jan Abel, 2004. "Exploring social welfare functions and violation of monotonicity: an example from inequalities in health--a comment," Journal of Health Economics, Elsevier, vol. 23(2), pages 331-332, March.
  7. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
  8. Paul Dolan & Aki Tsuchiya, 2011. "Determining the parameters in a social welfare function using stated preference data: an application to health," Applied Economics, Taylor & Francis Journals, vol. 43(18), pages 2241-2250.
  9. Ignacio Abasolo & Aki Tsuchiya, 2008. "Understanding preference for egalitarian policies in health: are age and sex determinants?," Applied Economics, Taylor & Francis Journals, vol. 40(19), pages 2451-2461.
  10. 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.
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