Measuring Aversion to Income-Related Health Inequality in Canada: An Equity-Efficiency Trade-Off Experiment

To estimate the extent to which people living in Canada are averse to income-related health inequalities, a critical component for equity-informative economic evaluations but lacking in the Canadian context.

We conducted 3 experiments among a sample of adults living in Canada to elicit value judgements about reducing income-related health inequality versus improving population health. Each experiment compared 2 programs: (experiment 1) universal and tailored vaccination, (experiment 2) nonspecific prevention programs, and (experiment 3) generic healthcare programs. The programs varied in terms of efficiency (additional life-years), and health inequality across income groups. Preferences were elicited using benefit trade-off analysis and were classified as follows: pro-rich (maximizing the health of individuals with the highest income), health maximizer (maximizing total health), weighted prioritarian (willing to trade some health to reduce inequalities), maximin (only improving the health of the individuals with the lowest income), and egalitarian (minimizing health inequalities at all costs).

We recruited 1000 participants per experiment. Preferences for the vaccination, prevention, and generic experiments were distributed as follows: pro-rich (aversion parameter <0): 31%, 22%, and 16%, respectively; health maximizers (aversion parameter = 0): 2%, 3%, and 2%, respectively; weighted prioritarians (aversion parameter > 0): 13%, 19%, and 22%, respectively; maximins (aversion parameter = ∞): 0%, 1%, and 3%, respectively; and egalitarian (aversion parameter undefined): 54%, 55%, and 57%, respectively. The median responses reflected a preference for minimizing income-related health inequalities across the 3 experiments.

Our findings suggest a strong aversion to income-related health inequality among the respondents with more than half being classified as egalitarians.