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Yang F, Jiang Y, Bai X, Cai Y, Duan H. Social equity perception and public mental health: a Chinese study with panel data. BMC Psychol 2023; 11:263. [PMID: 37667305 PMCID: PMC10478489 DOI: 10.1186/s40359-023-01296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Mental health is a vital part of an individual's overall health and well-being, and the relationship between society and individuals has always been a focus of academic and public attention. However, the effect of social equity perceptions on individual mental health remains unclear. METHODS Data were collected from 8,922 survey respondents with an average age of 47.533 years from the China Labor-force Dynamics Survey 2016 and 2018. The Center for Epidemiological Studies Depression scale was used to assess mental health. A two-way fixed effects regression model was used to determine the association between social equity perception and individual mental health. RESULTS Individuals with higher perceptions of social equity were more likely to report better mental health ([Formula: see text] = -0.944, p < 0.01). Happiness, life satisfaction, and social trust partially play mediating roles in the relationship between social equity perception and individual mental health, while education and age play moderating roles. CONCLUSION Social equity perception is a vital factor that affects mental health. Public policies should focus on helping less educated and older people improve their social equity perception to improve their mental health.
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Affiliation(s)
- Fan Yang
- Department of Labor and Social Security, School of Public Administration, Sichuan University, Chengdu, China
| | - Yao Jiang
- Department of Demography, Zhou Enlai School of Government, Nankai University, Tianjin, China.
| | - Xiu Bai
- Department of Labor and Social Security, School of Public Administration, Sichuan University, Chengdu, China
| | - Yuchen Cai
- Department of Labor and Social Security, School of Public Administration, Sichuan University, Chengdu, China
| | - Haiying Duan
- School of Economics, Sichuan University, Chengdu, Sichuan, China.
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Cadham CJ, Prosser LA. Eliciting Trade-Offs Between Equity and Efficiency: A Methodological Scoping Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:943-952. [PMID: 36805575 DOI: 10.1016/j.jval.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 02/12/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To identify differences in the approaches and results of studies that elicit equity-efficiency trade-offs that can inform equity-informative cost-effectiveness analysis for healthcare resource allocation. METHODS We searched Ovid (Medline), EconLit, and Scopus prior to June 25, 2021. Inclusion criteria were: (1) peer-reviewed or (2) gray literature; (3) published in English; (4) survey-based; (5) parameterized a social welfare function to quantify inequality aversion or (6) elicited a trade-off in equity and efficiency characteristics of health interventions. Exclusion criteria were: (1) studies that did not conduct a trade-off or (2) theoretical studies. We abstracted details on study methods, results, and limitations. Studies were grouped by following approach: (1) social welfare function or (2) preference ranking and distributional weighting. We described findings separately for each approach category. RESULTS Seventy-seven papers were included, 28 parameterized social welfare functions and 49 were classified as preference ranking and distributional weighting. Study methods were heterogeneous. Studies were conducted across 29 countries. Sample sizes and composition, survey methods and question framing varied. Preferences for equity were mixed. Across both approach categories: 39 studies were classified as clear evidence of inequality aversion; 33 found mixed evidence; and 4 had no evidence of aversion. Evidence of between and within-study heterogeneity was found. Preferences for equity may differ by gender, profession, political ideology, income, and education. CONCLUSIONS Substantial variability in study methods limit the direct comparability of findings and their use in equity-informed cost-effectiveness analysis. Future researches using representative samples that explore within and between country heterogeneity is needed.
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Affiliation(s)
- Christopher J Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Lisa A Prosser
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA
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Attema AE, L’Haridon O, van de Kuilen G. An experimental investigation of social risk preferences for health. THEORY AND DECISION 2023; 95:1-25. [PMID: 37361604 PMCID: PMC10133917 DOI: 10.1007/s11238-023-09928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 06/28/2023]
Abstract
In this paper, we use the risk apportionment technique of Eeckhoudt, Rey and Schlesinger (2007) to study higher order risk preferences for others' health as well as ex-ante and ex-post inequality preferences for social risky distributions, and their interaction. In an experiment on a sample of university students acting as impartial spectators, we observe risk aversion towards social health losses and a dislike of ex-ante inequality. In addition, evidence for ex-post inequality seeking is much weaker than evidence for ex-ante inequality aversion. Because ex-ante inequality aversion is unrelated to risk aversion, we conclude that simple forms of utilitarianism are not relevant for individual judgment of social risk over health. Last, our investigation of precautionary distribution, which would occur when one particular group in the society suffers from background health risk, shows substantial polarization of preferences. Supplementary Information The online version contains supplementary material available at 10.1007/s11238-023-09928-w.
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Affiliation(s)
- Arthur E. Attema
- Erasmus School of Health Policy and Management (ESHPM), EsCHER, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Olivier L’Haridon
- Univ Rennes, CNRS, CREM -UMR 6211, France and Institut Universitaire de France, F-35000 Rennes, France
| | - Gijs van de Kuilen
- Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands
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Attema AE, L'Haridon O, van de Kuilen G. Decomposing social risk preferences for health and wealth. JOURNAL OF HEALTH ECONOMICS 2023; 90:102757. [PMID: 37062256 DOI: 10.1016/j.jhealeco.2023.102757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 06/19/2023]
Abstract
This study reports the results of the first artefactual field experiment designed to measure the prevalence of aversion toward different components of social risks in a large and demographically representative sample. We identify social risk preferences for health and wealth for losses and gains, and decompose these attitudes into four different dimensions: individual risk, collective risk, ex-post inequality, and ex-ante inequality. The results of a non-parametric analysis suggest that aversion to risk and inequality is the mean preference for outcomes in health and wealth in the domain of gains and losses. A parametric decomposition of aversion to risk and inequality shows that respondents are averse to ex-post and ex-ante inequality in health and wealth for gains and losses. Likewise, respondents are averse to collective risk, but neutral to individual risk, which highlights the importance of considering different components of social risk preferences when managing social health and wealth risks.
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Affiliation(s)
- Arthur E Attema
- EsCHER, Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, Netherlands.
| | - Olivier L'Haridon
- CREM, Université de Rennes 1, Rennes, France, and Ghent University, Ghent, Belgium
| | - Gijs van de Kuilen
- Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands
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Attema AE, Brouwer WBF, Pinto‐Prades JL. Reference-dependent age weighting of quality-adjusted life years. HEALTH ECONOMICS 2022; 31:2515-2536. [PMID: 36057854 PMCID: PMC9826257 DOI: 10.1002/hec.4593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
People do not only care about maximizing health gains but also about their distribution. For example, they give more weight to younger patients than older patients. This pilot study aims to investigate if age weighting is reinforced by loss aversion if young people are falling behind one's perceived 'normal' quality of life (QoL), while older people do not. We apply a person trade-off method in a large representative sample (n = 990) to estimate age weighting factors. We also measure QoL levels that individuals regard as 'normal' for different ages, serving as reference points. We observe a considerable amount of age weighting, with 20-year-old patients on average receiving 1.7 times as much weight as 80-year-old patients. Perceived 'normal' QoL rapidly decreases with age of a patient. Older people are more optimistic about what constitutes 'normal QoL' than younger people, but they express a faster decline in normal QoL due to aging. Respondents who view all improvements to be gain enlarging show the least age weighting, but loss aversion cannot explain the results. Still, one's age-related reference level is an important predictor of age weights. Given the explorative nature of this study, further studies are called for to generate more robust evidence.
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Affiliation(s)
- Arthur E. Attema
- Erasmus School of Health Policy & Management (ESHPM)Erasmus UniversityRotterdamthe Netherlands
| | - Werner B. F. Brouwer
- Erasmus School of Health Policy & Management (ESHPM)Erasmus UniversityRotterdamthe Netherlands
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The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review. Arch Public Health 2021; 79:201. [PMID: 34794496 PMCID: PMC8600812 DOI: 10.1186/s13690-021-00729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background One of the most commonly used types of evaluation methods is cost-utility analysis (CUA), using the Quality Adjusted Life Year (QALY) indicator as a preference-based measure for assessing effects of a given programme. Such assessments are often translated into health-care provision priorities; therefore, effectively choosing the method of outcome evaluation is crucial for ensuring the best possible allocation of scarce resources. The main objective of this scoping review is to identify what kinds of problems and limitations may occur when the QALY indicator is used to assess the effects of health interventions in the older population. Methods To identify literature in a scoping review, the databases MEDLINE via PubMed and Scopus were searched. A manual search on relevant organizations’ and associations’ websites was also conducted (EUnetHTA, ISPOR and national governmental agencies responsible for allocation decisions). No limits concerning publication dates were set. All relevant data were extracted and analyzed, then a narrative summary was prepared. Results The database search identified 10,832 relevant items, finally 32 studies were included in the analysis. The main types of issues indicated in the studies were as follows: (1) lower life expectancy in the older population causes lower QALY gains; (2) an equal value of one QALY is used regardless of age; (3) poorer average health state causes lower QALY gains; (4) inadequate instruments to measure quality of life (QoL); (5) attributes of QoL used regardless of age; and (6) no beyond-health QoL aspects taken into account. Conclusions This review shows clearly that many problems of different types are connected with using QALY for the older population, but there is no consensus as to whether QALY discriminates against the older population or not – an opinion regarding this issue depends strongly on accepted principles, particularly the approach to equity and how one understands fairness. Health care resources should not be allocated solely on the basis of the health maximization rule because this can lead to discrimination against certain groups (e.g., older, disabled, and/or chronically ill people). To maintain the balance between efficiency and equity, the issues connected with age-based rationing should be widely discussed.
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Brendel F, Einhaus L, Then F. Resource scarcity and prioritization decisions in medical care: A lab experiment with heterogeneous patient types. HEALTH ECONOMICS 2021; 30:470-477. [PMID: 33184985 DOI: 10.1002/hec.4192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
During the COVID-19 pandemic, health care systems around the world have received additional funding, while at other times, financial support has been lowered to consolidate public spending. Such budget changes likely affect provision behavior in health care. We study how different degrees of resource scarcity affect medical service provision and, in consequence, patients' health. In a controlled lab environment, physicians are paid by capitation and allocate limited resources to several patients. This implies a trade-off between physicians' profits and patients' health benefits. We vary levels of resource scarcity and patient characteristics systematically and observe that most subjects in the role of physician devote a relatively stable share of budget to patient treatment, implying that they provide fewer services when they face more severe budget constraints. Average patient benefits decrease in proportion to physician budgets. The majority of subjects chooses an allocation that leads to equal patient benefits as opposed to allocating resources efficiently.
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Affiliation(s)
- Franziska Brendel
- Faculty of Economics and Business Administration, University of Duisburg-Essen, Essen, Germany
| | - Lisa Einhaus
- Faculty of Economics and Business Administration, University of Duisburg-Essen, Essen, Germany
- CINCH-Health Economics Research Center, University of Duisburg-Essen, Essen, Germany
| | - Franziska Then
- Faculty of Economics and Business Administration, University of Duisburg-Essen, Essen, Germany
- CINCH-Health Economics Research Center, University of Duisburg-Essen, Essen, Germany
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Hurley J, Mentzakis E, Walli-Attaei M. Inequality aversion in income, health, and income-related health. JOURNAL OF HEALTH ECONOMICS 2020; 70:102276. [PMID: 31955864 DOI: 10.1016/j.jhealeco.2019.102276] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
Based on a survey of a sample of the general public, we estimate inequality aversion across income, health, and bivariate income-health. Inequality aversion is domain specific: mean inequality aversion is greater for income than for health, but the underlying distributions of aversion attitudes differ, with a highly bi-modal distribution of inequality-aversion values for health in which nearly half the participants display very low aversion and nearly half display very high aversion. Aversion to income-related health inequality is greater than that to income or health alone. Consistent with previous literature, we find only weak associations between aversion attitudes and individual characteristics. The magnitude of the estimates implies potentially large gains in welfare from reducing inequality in these domains.
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Affiliation(s)
- Jeremiah Hurley
- Department of Economics and Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4M4.
| | - Emmanouil Mentzakis
- Department of Economics, University of Southampton, University Road, Southampton SO17 1BJ, United Kingdom
| | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2
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Attema AE, Brouwer WBF, Prades JLP. Peer effects in health valuation: the relation between rating of contemporaries' health and own health. Health Qual Life Outcomes 2018; 16:148. [PMID: 30055646 PMCID: PMC6064127 DOI: 10.1186/s12955-018-0978-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022] Open
Abstract
Background Most health valuation studies assume that individuals’ health valuations do not depend on social comparisons. However, there is some evidence that this assumption is not satisfied in practice. This paper tests whether self-rated health by means of a Visual Analogue Scale (VAS) is related to how one perceives the health of one’s contemporaries, while accounting for one’s health as classified by the EQ-5D classification system. Methods In a large sample (n = 1500), representative of the general public, we use a VAS to rate respondents’ own health and their assessment of their contemporaries’ health. In addition, we directly ask them whether they perceive their health to be better, the same, or worse than their contemporaries, and we measure their own health according to the EQ-5D-5 L. Results We find a positive relationship between own health rating and contemporaries’ health rating, after controlling for the respondents’ own health as classified according to the EQ-5D. Furthermore, we observe a discrepancy between relative health vis-à-vis age peers as measured by an ordinal comparison and relative health as measured by a VAS. Finally, respondents, especially women, tended to overestimate the health of other people of their age. Conclusions We provide evidence that people’s own health rating is related to the perception of health of contemporaries. Our results indicate that knowledge about a respondent’s perception of others’ health is useful in explaining health state valuations.
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Affiliation(s)
- Arthur E Attema
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | | | - Jose Luis Pinto Prades
- Department of Economics, Universidad de Navarra, Pamplona, Spain.,Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK
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Robson M, Asaria M, Cookson R, Tsuchiya A, Ali S. Eliciting the Level of Health Inequality Aversion in England. HEALTH ECONOMICS 2017; 26:1328-1334. [PMID: 27649686 PMCID: PMC6120144 DOI: 10.1002/hec.3430] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 07/27/2016] [Accepted: 08/30/2016] [Indexed: 05/12/2023]
Abstract
Health inequality aversion parameters can be used to represent alternative value judgements about policy concern for reducing health inequality versus improving total health. In this study, we use data from an online survey of the general public in England (n = 244) to elicit health inequality aversion parameters for both Atkinson and Kolm social welfare functions. We find median inequality aversion parameters of 10.95 for Atkinson and 0.15 for Kolm. These values suggest substantial concern for health inequality among the English general public which, at current levels of quality adjusted life expectancy, implies weighting health gains to the poorest fifth of people in society six to seven times as highly as health gains to the richest fifth. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Matthew Robson
- Department of Economics and Related StudiesUniversity of YorkYorkUK
| | | | | | - Aki Tsuchiya
- Department of Economics, and School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Shehzad Ali
- Department of Health SciencesUniversity of YorkUK
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