Univariate Health-Related Inequality Aversion in Sweden: Evidence of Nonconstant Aversion and Support for Prioritizing the Worse Off

OBJECTIVES: To test whether the assumption of constant health-related inequality aversion holds for Atkinson and Kolm-Pollak social welfare functions (SWFs) and to assess whether there is public support in Sweden for prioritizing the worse off when allocating health care resources. METHODS: = 1,654) completed two task sets in which they chose between interventions benefiting better-off and worse-off groups to different extents. To test for constant inequality aversion, we checked whether the inequality-aversion parameter from the second task set was one of the parameters closest to that elicited from the first set. RESULTS: A majority displayed nonconstant inequality aversion (71.4% for Atkinson, 72.3% for Kolm-Pollak). However, the design may not fully isolate inequality aversion from age preferences and cannot rule out learning effects. Among the valid responses (n = 1,029), 50.4% valued health gains to worse off higher, but only up to a point; 19.4% were unwilling to help the better off before nothing more could be done for the worse off; 14.4% preferred a more egalitarian system; 10.8% were unwilling to sacrifice total health gains to benefit one group more than the other; and 4.8% were willing to sacrifice total health to benefit the better off more than the worse off. CONCLUSIONS: If our findings were not confounded by age preferences or learning effects, the Atkinson and Kolm-Pollak SWFs would not seem to reflect the sample's preferences for prioritizing the worse off. Most respondents traded efficiency for equity in ways largely consistent with Swedish health care priority setting.