A Fair Test of the Fair Innings?

Abstract

Priority setting in health care under conventional rules of health economic evaluation is based upon the ethos of attempting to maximize post-treatment health gain given available health care resources. In his later years, Alan Williams advocated the "fair innings argument,'' which balances differences in whole lifetime experiences of health with differences in post-treatment outcomes when prioritizing people for health care. This article reports a study that presented respondents with a number of abstract health care decision contexts in an attempt to test the extent to which post-treatment health maximization, the fair innings argument, or, indeed other "decision rules,'' are evident in the respondents' answers. The results indicate that the most commonly observed decision rule differs substantially across health care contexts, and therefore imply that rather than pursue an overarching decision rule, it may be more appropriate to vary the rule according to the particular health care decision context under consideration.