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Abstract
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.
Highlights
IntroductionYou can expect to live a shorter life than if you were rich [1, 2], you can expect to live with lower average health-related quality of life [3], and you can expect to experience disability at a younger age [4]
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 groups1 [6,7,8,9]—they appear to be “distributionally sensitive”
To explore whether or not aversion differs depending upon whether participants were told that the inequality existed between socioeconomic groups, or neutrally framed groups
Summary
You can expect to live a shorter life than if you were rich [1, 2], you can expect to live with lower average health-related quality of life [3], and you can expect to experience disability at a younger age [4]. This “health gap” is substantial [5]. This apparent discordance has led some to question the democratic legitimacy of distributionally naïve approaches, and to call for distributionally sensitive forms of economic evaluation, such as “distributional cost-effectiveness analysis” [12,13,14]
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