Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences

Background The trade-off that society is willing to make to promote a more equitable distribution of health can be represented as a social welfare function (SWF). SWFs are an economic construct that can be used to illustrate concerns for total health with aversion to inequalities between socioeconomic groups. Objective This study used people’s preferences to estimate the shapes of health-related SWFs (HRSWFs). We tested the suitability of this method to derive equity weights. Methods A questionnaire was used to elicit preferences concerning trade-offs between the total level of health and its distribution among two socioeconomic groups. The participant group was a sample of convenience that included a mix of health researchers, academics, clinicians, managers, public servants and research students. The data collected were used to develop HRSWFs with a constant elasticity of substitution. The weight was calculated using the marginal rate of substitution. Results A marginal health gain to the lowest socioeconomic position (SEP) group was valued 14.1–81.4 times more than a marginal health gain to the high SEP group. Conclusions Our results provide evidence to support the idea that the public may be willing to make trade-offs between efficiency and equity, and that they value health gains differently depending on which socioeconomic group receives the health gain. Further evidence is required before such indicative weights have practical value.