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Aversion to geographic inequality and geographic variation in preferences in the context of healthcare

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Abstract

Background

It is now widely accepted that social values have a role to play in terms of healthcare resource allocation decisions. Furthermore, with the recent focus on decentralization, geographic variation in preferences has become a pertinent issue. However, the geographic dimension of inequality in the distribution of health gains across different regions has received little attention in the literature.

Objectives

To elicit the general public’s preferences regarding inequality in the distribution of health gains across regions and to test the assumption of variation in preferences across regions.

Methods

A questionnaire was developed to elicit social and personal preferences. The first preference questions focused on the criteria of maximization of health gain and geographic equality of health gain. Person trade-off questions were used to assess trade-offs and inequality aversion. The latter preference questions focused on attributes of healthcare delivery. The questionnaire was administered in two Portuguese municipalities. Samples from both localities were defined by quotas based on the composition of local populations. Overall, 70 respondents (half from each municipality) self-completed the questionnaire.

Results

Respondents agreed or strongly agreed that both maximization of health gain and geographic equality of health gain should be considered in resource allocation decisions; when they were asked to make trade-offs, 70–80% were prepared to do so. Of those making trade-offs, most people were willing to forego 10–30% of total health gain to keep geographic equality of health gain in return. Regarding inequality aversion, the results indicate that there was some aversion to inequality in the sample. Regarding preference variation, the results do not corroborate the hypothesis of variation in preferences across regions.

Conclusion

These results suggest that the general public supports the principles of maximization of health gain and geographic equality in the distribution of health gain. The results further suggest the existence of aversion to inequality, subject to a maximum opportunity cost. Further research is required into preference variation; in particular, in larger samples, and in other regions of Portugal.

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Notes

  1. 1The term ‘postcode lottery’ was used to represent situations in which, depending on where people lived, some drugs or treatments would be provided, or not, within the NHS.

  2. 3In the case of TOFF4, we calculated r taking into account only two regions (the total health gain under alternative A was therefore adjusted). Also, we assumed that the respondents who chose alternative A in the first part of question 4 would have chosen alternative B if the two alternatives presented the same total health gain, with this gain being equally distributed between regions in the case of alternative B (as happened in question 3).

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Acknowledgements

This study is based on a chapter from my PhD thesis, thus I would like to thank my supervisor, Anthony J. Culyer, and the examiners, Paul Dolan and Richard Cookson, for their suggestions for improving the final work. For their pertinent suggestions about the questionnaire design, I would like to thank Aki Tsuchiya and Pedro Ferreira. I am grateful to Óscar Lourenço for his helpful comments regarding the analysis of the empirical results. I would also like to thank the precious help received from all who filled out and helped me to administer the questionnaire. Finally, I would like to thank the editor and two anonymous referees for their helpful comments. Naturally, I retain full responsibility for opinions expressed and any remaining errors.

This study received funding from the Fundaça~o para a Ciência e Tecnologia. The author has no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Faculty of Economics, University of Coimbra, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal

    Carlota Quintal

  2. Centre for Health Studies and Research, University of Coimbra, Coimbra, Portugal

    Carlota Quintal

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  1. Carlota Quintal
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Correspondence to Carlota Quintal.

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Quintal, C. Aversion to geographic inequality and geographic variation in preferences in the context of healthcare. Appl Health Econ Health Policy 7, 121–136 (2009). https://doi.org/10.1007/BF03256146

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