Eliciting the Level of Health Inequality Aversion in England

Robson, Matthew; Asaria, Miqdad; Cookson, Richard; Tsuchiya, Aki; Ali, Shehzad

doi:10.1002/hec.3430

Cited by 55 publications

(73 citation statements)

References 14 publications

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“…Research programmes are fortunately progressing in tackling the substantial theoretical and empirical difficulties in quantifying equity and financial impacts in ways suitable for integration in decision-making. [25][26][27] Efficiency and Ethics DPU argue that "[s]ometimes reducing the unfair distribution of health in a population … should be given priority over making a health system more efficient (eg, by pursuing what is most cost-effective to maximize health)" [p1]. 3 This seems eminently reasonable but is actually problematic on grounds of the implied meaning of "efficiency. "…”

Section: The Reference Casementioning

confidence: 99%

HTA – Algorithm or Process? Comment on "Expanded HTA: Enhancing Fairness and Legitimacy"

Culyer

2016

Int J Health Policy Manag

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Daniels, Porteny and Urrutia et al make a good case for the idea that that public decisions ought to be made not only "in the light of " evidence but also "on the basis of " budget impact, financial protection and equity. Health technology assessment (HTA) should, they say, be accordingly expanded to consider matters additional to safety and cost-effectiveness. They also complain that most HTA reports fail to develop ethical arguments and generally do not even mention ethical issues. This comment argues that some of these defects are more apparent than real and are not inherent in HTA -as distinct from being common characteristics found in poorly conducted HTAs. More generally, HTA does not need "extension" since (1) ethical issues are already embedded in HTA processes, not least in their scoping phases, and (2) HTA processes are already sufficiently flexible to accommodate evidence about a wide range of factors, and will not need fundamental change in order to accommodate the new forms of decision-relevant evidence about distributional impact and financial protection that are now starting to emerge. HTA and related techniques are there to support decision-makers who have authority to make decisions. Analysts like us are there to support and advise them (and not to assume the responsibilities for which they, and not we, are accountable). The required quality in HTA then becomes its effectiveness as a means of addressing the issues of concern to decisionmakers. What is also required is adherence by competent analysts to a standard template of good analytical practice. The competencies include not merely those of the usual disciplines (particularly biostatistics, cognitive psychology, health economics, epidemiology, and ethics) but also the imaginative and interpersonal skills for exploring the "real" question behind the decision-maker's brief (actual or postulated) and eliciting the social values that necessarily pervade the entire analysis. The product of such exploration defines the authoritative scope of an HTA. H ealth technology assessment (HTA) can be seen as a form of policy research, 1 as a culturally specific construct 2 as a source of good evidence 3 or, as I shall suggest, as a decision-making process that is embedded in further public and professional policy processes. Daniels, Porteny and Urrutia (henceforth DPU) 3 make a good case for the idea that public decisions ought to be made not only "in the light of " evidence but also "on the basis of " budget impact, financial protection and equity. HTA [1] should accordingly, they say, be expanded to consider matters other than safety and cost-effectiveness [2] . The phrases in quotation marks imply the necessity for conversation and deliberation amongst the deciders or their advisers. However, "most HTA reports … fail to develop ethical arguments and generally do not even mention ethical issues" [p. 1], 3 a view shared by others. 6,7 At this (quantitative) point about "most" papers, a paper by Hoffman 8 is cited which does not, unfortunately, sta...

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Section: The Reference Casementioning

confidence: 99%

HTA – Algorithm or Process? Comment on "Expanded HTA: Enhancing Fairness and Legitimacy"

Culyer

2016

Int J Health Policy Manag

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“…One strand of this literature in the health field has investigated health inequality aversion, that is, social attitudes towards trade-offs between improving sum total health and reducing socioeconomic inequality in health (Abasolo & Tsuchiya, 2004;Ali, Tsuchiya, Asaria, & Cookson, 2017;Cropper, Krupnick, & Raich, 2016;Dolan & Tsuchiya, 2011;Edlin, Tsuchiya, & Dolan, 2012;Robson, Asaria, Cookson, Tsuchiya, & Ali, 2016), in the context of a wider literature on equity and the economic evaluation of health programs (Baker et al, 2010;Cookson, Griffin, & Nord, 2014;Cookson et al, 2017;Donaldson et al, 2011;Lancsar, Wildman, Donaldson, Ryan, & Baker, 2011). In these studies, health inequality aversion can be quantified using a parameter in a social welfare function.…”

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confidence: 99%

E‐learning and health inequality aversion: A questionnaire experiment

et al. 2018

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In principle, questionnaire data on public views about hypothetical trade‐offs between improving total health and reducing health inequality can provide useful normative health inequality aversion parameter benchmarks for policymakers faced with real trade‐offs of this kind. However, trade‐off questions can be hard to understand, and one standard type of question finds that a high proportion of respondents—sometimes a majority—appear to give exclusive priority to reducing health inequality. We developed and tested two e‐learning interventions designed to help respondents understand this question more completely. The interventions were a video animation, exposing respondents to rival points of view, and a spreadsheet‐based questionnaire that provided feedback on implied trade‐offs. We found large effects of both interventions in reducing the proportion of respondents giving exclusive priority to reducing health inequality, though the median responses still implied a high degree of health inequality aversion and—unlike the video—the spreadsheet‐based intervention introduced a substantial new minority of non‐egalitarian responses. E‐learning may introduce as well as avoid biases but merits further research and may be useful in other questionnaire studies involving trade‐offs between conflicting values.

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“…The search strategy was developed in an iterative fashion. First, six "pearls" [22] were identified as starting points, to provide the initial list of key words [6,8,[23][24][25][26]. Second, the MeSH headings associated with these papers were recorded, and a word frequency analysis of the paper titles/ abstracts was undertaken [27].…”

Section: Search Strategymentioning

confidence: 99%

“…Of the 15 studies identified, 8 provided estimates of aversion to inequalities in health between neutrally labelled groups [23,24,31,33,[35][36][37][38], whilst 7 provided estimates of aversion to inequalities in health between socioeconomic groups [6][7][8][9][39][40][41].…”

Section: Choice Contextmentioning

confidence: 99%

“…Recent evidence suggests the UK public are averse to this inequality, and would be willing to sacrifice a significant amount of average population lifetime health to achieve a more even distribution of it between socioeconomic groups 1 [6][7][8][9]-they appear to be "distributionally sensitive". In contrast, economic evaluation in health is typically "distributionally naïve" [10], and operates under the assumption that "a QALY is a QALY is a QALY" [11], irrespective of who receives it.…”

Section: Introductionmentioning

confidence: 99%

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How averse are the UK general public to inequalities in health between socioeconomic groups? A systematic review

et al. 2019

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There is growing interest in the use of "distributionally-sensitive" forms of economic evaluation that capture both the impact of an intervention upon average population health and the distribution of that health amongst the population. This review aims to inform the conduct of distributionally sensitive evaluations in the UK by answering three questions: (1) How averse are the UK public towards inequalities in lifetime health between socioeconomic groups? (2) Does this aversion differ depending upon the type of health under consideration? (3) Are the UK public as averse to inequalities in health between socioeconomic groups as they are to inequalities in health between neutrally framed groups? EMBASE, MEDLINE, EconLit, and SSCI were searched for stated preference studies relevant to these questions in October 2017. Of the 2155 potentially relevant papers identified, 15 met the predefined hierarchical eligibility criteria. Seven elicited aversion to inequalities in health between socioeconomic groups, and eight elicited aversion between neutrally labelled groups. We find general, although not universal, evidence for aversion to inequalities in lifetime health between socioeconomic groups, albeit with significant variation in the strength of that preference across studies. Second, limited evidence regarding the impact of the type of health upon aversion. Third, some evidence that the UK public are more averse to inequalities in lifetime health when those inequalities are presented in the context of socioeconomic inequality than when presented in isolation.

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Eliciting the Level of Health Inequality Aversion in England

Cited by 55 publications

References 14 publications

HTA – Algorithm or Process? Comment on "Expanded HTA: Enhancing Fairness and Legitimacy"

HTA – Algorithm or Process? Comment on "Expanded HTA: Enhancing Fairness and Legitimacy"

E‐learning and health inequality aversion: A questionnaire experiment

How averse are the UK general public to inequalities in health between socioeconomic groups? A systematic review

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