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Social Choice, Health and Fairness


  • Paul Anand

    () (Department of Economics, Faculty of Social Sciences, The Open University)


The main conceptual framework of classical social choice places preference conflicts between agents centre-stage. This paper develops the case for a second conception of social choice where entitlements are established through the integration of different, primitive classes of claim and supports the thesis with an examination of its application to health-care rationing. It begins by arguing that the axiomatic characterisation of dictatorship and its association with unfairness are both flawed. The paper then proposes that fair social choices integrate different types of claims and shows how non-linear programming can provide an optimisation framework for doing this. Four claims types are identified as particularly significant: consequences, de-ontological claims such as rights, contracts including social contracts and political mandates, and beliefs about procedural fairness. It is then shown how the existence of these claims helps make sense of objections to QALY maximisation, a hitherto predominant social welfare function in health economics. Throughout the paper, the emphasis is on the nature of theory required to structure empirical social choice whilst capturing, formally, ethical objections to a widely used social choice procedure.

Suggested Citation

  • Paul Anand, 2002. "Social Choice, Health and Fairness," Open Discussion Papers in Economics 44, The Open University, Faculty of Social Sciences, Department of Economics.
  • Handle: RePEc:opn:wpaper:44

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    More about this item


    non-linear programming; fairness; QALY maximisation; empirical social choice;

    JEL classification:

    • D60 - Microeconomics - - Welfare Economics - - - General
    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • I10 - Health, Education, and Welfare - - Health - - - General


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