A universal preference for equality in health? Reasons to reconsider properties of applied social welfare functions

• Published in: Social science & medicine (1982) 2012-11, Vol.75 (10), p.1836-1843
• Main Authors: Mæstad, Ottar, Norheim, Ole Frithjof
• Format: Article
• Language: English
• Subjects: Allocations; Biological and medical sciences; Eliciting preferences; Equality; Health; Health equity; Health Status; Health Status Disparities; Health Status Indicators; Humans; Income; Inequality; Mathematical functions; Medical sciences; Miscellaneous; Norway; Preferences; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality-Adjusted Life Years; Resource allocation; Social Justice; Social Values; Social Welfare; Social welfare function; Welfare economics
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2012.07.001

The literature on how to combine efficiency and equity considerations in the social valuation of health allocations has borrowed extensively from applied welfare economics, including the literature on inequality measurement. By so doing, it has adopted normative assumptions that have been applied for evaluating the allocation of welfare (or income) rather than the allocation of health, including the assumption of a monotonically declining social marginal value of welfare/income/health. At the same time, empirical studies that have elicited social preferences for allocation of health have reported results that are seemingly incompatible with this assumption. There are two ways of addressing this inconsistency; we may censor the stated preferences by arguing that they cannot be supported by normative arguments, or we may reject or modify the analytical framework in order to accommodate the stated preferences. We argue that the stated preferences can be supported by normative reasoning and therefore conclude that one should be cautious in applying the standard welfare economic framework to the allocation of health. ► Standard social welfare functions presume that greater equality of health outcomes is always desirable. ► However, empirical studies show that people do not necessarily have a universal preferences for equality in health. ► We argue that there are good normative reasons for not endorsing a universal preference for equality in health. ► We conclude that one should be cautious in applying standard welfare functions to the allocation of health.