Development of a questionnaire to elicit public preferences regarding health inequalities

A review of relevant literature within health economics, psychology and moral philosophy suggests that people want resource allocation decisions in health to be informed by considerations of equity as well as efficiency. A number of empirical studies demonstrate that people are willing to sacrifice overall health benefits for a more equal distribution of health (Dolan and Shaw, 2001a). However, it is not clear from the available evidence exactly which distributional considerations people want to take into account when allocating resources. Further, on the whole, discussions about equity are rarely cast in quantitative terms (but see Olsen, 1994) and so it is not clear to what extent people want various equity notions to be taken into account. In this study funded by the ESRC Health Variations Programme, we have elicited the views of the general public in order to quantify people’s preferences regarding equity in health. The two-year study first explored whether people wish to give differential priority to groups with different characteristics (such as age, family responsibilities and the extent to which people are ‘responsible’ for their illness). The study then derived a way of asking questions on various inequality issues which enable people to indicate their strength of preference for different sorts of reduction in health inequalities. This paper reports upon these attempts to present to members of the general public meaningful trade-offs between efficiency and equity. The purpose of this paper is to report on the development of the questions and to indicate how they might be used by other researchers. Part A shows how the questions were developed from a series of pilot interviews and made suitable for use in either an interview setting or postal survey. Part B provides some guidance on administration and reproduces the questions in order to make them available to interested researchers and policy makers. Those readers whose main aim is to access the questions, may wish to move straight in to Part B.