Fair distribution of health

A central question in the allocation of scarce resource for health is how to balance the desire to achieve the maximal aggregate health benefit against concerns about the fairness of the distribution of health. The literature suggests two alternative approaches in order to deal with these concerns in a systematic way. The first one draws on the literature on income inequality by constructing measures of the inequality in health, and by proposing ways of constructing measure of aggregate goodness by combining measures of health inequality and measures of aggregate health (i.e., the inequality adjustment approach). The second approach stems from the cost-effectiveness literature. While distributional concerns are not incorporated into standard cost effectiveness analysis, such concerns can easily be accommodated within this framework by attaching distributional weights to health outcomes. This distributional weighting approach will, in the same way as the inequality adjustment approach, produce an overall measure of goodness that represents both the concern for aggregate health (efficiency) and the concern for a fair distribution of health (equity). The two approaches have rather different implications for how to empirically elicit distributional preferences for health. However, the existing literature does neither discuss the relationship between the alternative approaches nor their respective normative underpinnings. There are three aims of this project: 1) To analyse the characteristics and limitations of alternative ways of incorporating fairness considerations into health policy analysis. 2) To critically examine the normative underpinnings of the alternative approaches. 3) To point out implications for future work on the elicitation of distributional preferences over health outcomes.