Are public preferences over health distributions guided by principles of distribution? A social choice experiment

Policymakers must decide how to distribute limited healthcare resources and may wish to draw upon public preferences to identify whom to prioritise. However, little is known about the reasons underlying these preferences. The aim of this study is to examine public preferences over health distributions and the extent to which the reasons underlying them reflect one of the following principles of distribution: equality, need, responsibility, or efficiency.

In an online experiment administered among members of the general public in the United Kingdom, respondents (n = 648) distributed resources to determine the health of hypothetical recipients identified by sex, income or smoking-status. They provided the main reason for their choices in an open text response, and we classified their responses into one of the four principles. We used multinomial logistic regression models to examine the relationship between the preferences and principles.

The majority of respondents gave equal priority to male and female recipients (83.9%) and low- and high-income recipients (52.8%). Those who prioritised, distributed more resources for health to low-income recipients (40.2%) and non-smoking recipients (69.3%). The most prominent principles were equality for sex, equality and need for income, and responsibility for smoking-status. These principles were strongly and significantly associated with preferences over health distributions (R²>0.34), and explained more variation in preferences than socio-demographic characteristics (R²<0.06).

These findings can inform health policy and policy messaging regarding the distribution of healthcare resources and increase their legitimacy.