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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

Suggested Citation

  • Ignacio Abásolo & Aki Tsuchiya, 2013. "Is more health always better for society? Exploring public preferences that violate monotonicity," Theory and Decision, Springer, vol. 74(4), pages 539-563, April.
  • Handle: RePEc:kap:theord:v:74:y:2013:i:4:p:539-563 DOI: 10.1007/s11238-011-9292-1

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    References listed on IDEAS

    1. 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.
    2. 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.
    3. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the 'Fair Innings' Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132.
    4. 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.
    5. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
    6. 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.
    7. 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.
    8. 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.
    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. 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.
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    Cited by:

    1. Matthew Robson & Miqdad Asaria & Richard Cookson & Aki Tsuchiya & Shehzad Ali, 2017. "Eliciting the Level of Health Inequality Aversion in England," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1328-1334, October.
    2. Attema, Arthur E. & Brouwer, Werner B.F. & l’Haridon, Olivier & Pinto, Jose Luis, 2015. "Estimating sign-dependent societal preferences for quality of life," Journal of Health Economics, Elsevier, vol. 43(C), pages 229-243.
    3. Gu, Yuanyuan & Lancsar, Emily & Ghijben, Peter & Butler, James RG & Donaldson, Cam, 2015. "Attributes and weights in health care priority setting: A systematic review of what counts and to what extent," Social Science & Medicine, Elsevier, vol. 146(C), pages 41-52.

    More about this item


    Health-Related Social Welfare Functions; Monotonicity; Rawlsian; Equality-efficiency trade-off; D39; D63; I10;

    JEL classification:

    • D39 - Microeconomics - - Distribution - - - Other
    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • I10 - Health, Education, and Welfare - - Health - - - General


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