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The second paper of my PhD is out in @socscimed! Co-authors: Aki Tsuchiya and @JHolmesSheff. We explore the UK-public's willingness to prioritise disadvantaged socioeconomic groups over advantaged socioeconomic groups for health gains, and find ... (1/x) https://www.sciencedirect.com/science/article/abs/pii/S0277953620307929
The UK-public are willing to prioritise the socioeconomically disadvantaged for pain relief, improvement of mobility problems and life-expectancy gains. This supports use of “distributionally sensitive” forms of economic evaluation, such as DCEA... in addition (2/x)
We find participant choices were influenced by non-health differences between socioeconomic groups, including inequalities in income, broader non-health inequalities, the potential to access to private healthcare, and the potential to use money to adapt to health problems. (3/x)
We also find evidence the public are less willing to prioritise people with unknown socioeconomic status and lower lifetime health over people with unknown socioeconomic status and higher lifetime health, compared to when they are told the groups are socioeconomic unequal (4/x)
In combination, these last two points motivate a normative debate about whether distributional cost-effectiveness analysis should use estimates of the UK-public's aversion to inequalities in health between socioeconomic groups or neutrally labelled groups... (5/x)
In other words, should we deprioritise the health of the socioeconomically advantaged because they have more money than poorer people? How about simply because they have more lifetime health? (6/x)
If it is the later, should we use estimates of aversion between "socioeconomically neutrally" labelled groups instead? Or would use of these "neutral" preferences whitewash the legitimate injustice of socioeconomic inequalities in health? (7/x)
We don't argue either way in this paper, but I have significant concerns about the extent of public support for NHS/NICE/DHSC down-weighting health gains provided to socioeconomically advantaged people on the basis of the fact they have more money than the disadvantaged. (8/x)
Given this, I am learning towards use "neutral" estimates of inequality aversion, and "health exclusive" forms of DCEA (i.e. prioritising those with lower lifetime health equally irrespective of their socioeconomic circumstance), but am happy to hear counter-arguments (9/x)
What do you think? Socioeconomic based weights, neutral weights? Also - this paper is not open access, but if you email me at [email protected], I would be happy to send you the accepted version in word format. (10/10)
@ScHARRSheffield @SipherC @pmeiersheffield @RichardACookson @miqedup @OFNorheim - also @felly500 @DrChrisGibbons - half the participants in this study were from Sheffield.
