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Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences.

ABSTRACT: BACKGROUND:The trade-off that society is willing to make to promote a more equitable distribution of health can be represented as a social welfare function (SWF). SWFs are an economic construct that can be used to illustrate concerns for total health with aversion to inequalities between socioeconomic groups. OBJECTIVE:This study used people's preferences to estimate the shapes of health-related SWFs (HRSWFs). We tested the suitability of this method to derive equity weights. METHODS:A questionnaire was used to elicit preferences concerning trade-offs between the total level of health and its distribution among two socioeconomic groups. The participant group was a sample of convenience that included a mix of health researchers, academics, clinicians, managers, public servants and research students. The data collected were used to develop HRSWFs with a constant elasticity of substitution. The weight was calculated using the marginal rate of substitution. RESULTS:A marginal health gain to the lowest socioeconomic position (SEP) group was valued 14.1-81.4 times more than a marginal health gain to the high SEP group. CONCLUSIONS:Our results provide evidence to support the idea that the public may be willing to make trade-offs between efficiency and equity, and that they value health gains differently depending on which socioeconomic group receives the health gain. Further evidence is required before such indicative weights have practical value.

SUBMITTER: Lal A

PROVIDER: S-EPMC5820237 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences.

Lal Anita A Siahpush Mohammad M Moodie Marjory M Peeters Anna A Carter Robert R

PharmacoEconomics - open 20180301 1

<h4>Background</h4>The trade-off that society is willing to make to promote a more equitable distribution of health can be represented as a social welfare function (SWF). SWFs are an economic construct that can be used to illustrate concerns for total health with aversion to inequalities between socioeconomic groups.<h4>Objective</h4>This study used people's preferences to estimate the shapes of health-related SWFs (HRSWFs). We tested the suitability of this method to derive equity weights.<h4>M ...[more]

PMID: 29464669

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Project description:BACKGROUND:To throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18-65. METHODS:By applying linear regressions to data from the 2010 National Survey on Risk Factors and Chronic Diseases, the analysis explored the SEP-health gradient along three SEP dimensions - education, occupation, and skin colour - using ten health measures: self-reported health (SRH), general and abdominal obesity, hypertension, high glucose, high cholesterol, high triglycerides, low high-density lipoprotein cholesterol, metabolic syndrome, and cumulative risk factors. Regressions also included behaviours and health-related risk perceptions (tobacco and alcohol consumption, diet, physical activity, and risk-related behaviours). It thus investigated the SEP-health gradient and its underlying mechanisms via both behaviours and health-related risk perceptions. RESULTS:Once controlling for gender, age, marital status, region and provincial dummies, the analysis detected educational gradients in SRH (estimated coefficient [95% CI]: middle-level education?=?3.535 [1.329, 5.741], p?<?0.01; high-level education?=?5.249 [3.050, 7.448], p?<?0.01) that are partially explainable by both health-affecting behaviours (tobacco and alcohol consumption, diet, physical and sedentary activity) and risk perceptions. Using objective measures of health, however, it found no SEP-health gradients other than hypertension among people identified as having Black skin color (adjusted for demographic variables, 0.060 [0.018, 0.101], p?<?0.01) and high cholesterol among those identified as having Mulatto or Mestizo skin color (adjusted for demographic variables, -?0.066 [-?0.098, -?0.033], p?<?0.01). CONCLUSIONS:In terms of objective health measures, the study provides minimal evidence for an SEP-health gradient in Cuba, results primarily attributable to the country's universal healthcare system - which offers full coverage and access and affordable medications - and its highly developed education system.

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Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences.

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Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences.

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