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Preference for equity as a framing effect.

P A Ubel1, J Baron, D A Asch

  • 1Veterans Affairs Medical Center, Ann Arbor, Michigan, USA. paubel@umich.edu

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|June 2, 2001
PubMed
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Public preferences for health equity over efficiency in screening tests are easily swayed by how information is presented. Framing effects and the order of scenarios significantly impact choices, urging caution for policymakers.

Area of Science:

  • Health economics
  • Behavioral economics
  • Public health policy

Background:

  • Previous research indicates a public preference for distributing less effective screening tests broadly over more effective tests to a smaller group.
  • This preference for equity diminishes when the less effective test is not offered to the entire population.
  • This study investigates the susceptibility of equity vs. efficiency preferences to framing effects.

Purpose of the Study:

  • To examine if framing effects and order of presentation influence public preferences between equity and efficiency in health screening allocation.
  • To understand how the presentation of population coverage and geographic scope impacts these preferences.

Main Methods:

  • Two studies were conducted involving subjects presented with scenarios of screening tests.

Related Experiment Videos

  • Scenarios varied in budget constraints, lives saved, proportion of population receiving tests, and geographic scope (single vs. multiple states).
  • The order in which scenarios were presented to subjects was also manipulated.

    • Main Results:

    • Preference for equity over efficiency was significantly influenced by framing; broader distribution was favored when it covered the entire population versus half.
    • Order effects were observed, with equity preference being stronger when scenarios involving universal coverage were presented first.
    • Framing effects persisted even with identical circumstances; broad framing across states reduced equity preference compared to narrow framing within one state.

    Conclusions:

    • Public preferences for equity in health resource allocation are not stable and can be manipulated by framing and order effects.
    • Policymakers should critically evaluate public input on equity vs. efficiency, recognizing its susceptibility to presentation biases.
    • Further research is needed to understand the cognitive mechanisms behind these framing effects in health policy decisions.