Incorporating Concern for Health Equity Into Resource Allocation Decisions: Development of a Tool and Population-Based Valuation for Uganda

Health economic analyses that simultaneously address the concerns of increasing population health and reducing health inequalities require information on public preferences for using healthcare resources to reduce health inequalities and how this is valued relative to improving total population health. Previous research has quantified this preference in the form of an inequality aversion parameter in a specified social welfare function. This study aimed to elicit general population’s views on health inequality and to estimate an inequality aversion parameter in Uganda.Adult respondents from the general population were recruited and interviewed using survey adapted from an existing questionnaire, including trade-off questions between 2 hypothetical healthcare programs. Data on participants’ demographic and socioeconomic characteristics and health-related quality of life measured by 5-level version of EQ-5D were collected.A nationally representative sample of 165 participants were included, with mean age of 37.1 years and mean 5-level version of EQ-5D at 0.836. Most respondents indicated willingness to trade-off some total population health to reduce health inequality. Translating the preferences into an Atkinson inequality aversion parameter (14.70) implies that health gain to the poorest 20% of people should be given approximately 6 times the weight of health gains to the richest 20%.Our study suggests it is feasible to adapt questionnaires of this type for a Ugandan population and this approach could be used to measure public aversion to health inequality in other settings. The elicited inequality aversion parameter can be used to support the assessment of health inequality impact in economic evaluation in Uganda.

同时关注增加人口健康和减少健康不平等问题的卫生经济分析需要了解公众对于使用医疗资源减少健康不平等的偏好，以及这种偏好相对于改善总体人口健康的价值。先前的研究已经在特定的社会福利函数中以不平等厌恶参数的形式对这种偏好进行了量化。本研究旨在了解乌干达普通民众对健康不平等的看法，并估算不平等厌恶参数。 从普通民众中招募成年受访者，并使用根据现有问卷改编的调查问卷进行访谈，其中包括两个假设的医疗保健项目之间的权衡问题。收集了参与者的人口统计学和社会经济特征数据以及通过五维健康量表（EQ - 5D）的五级版本测量的与健康相关的生活质量数据。 纳入了具有全国代表性的165名参与者样本，平均年龄为37.1岁，五级版本的EQ - 5D平均得分为0.836。大多数受访者表示愿意牺牲一些总体人口健康来减少健康不平等。将这些偏好转化为阿特金森不平等厌恶参数（14.70）意味着，最贫困的20%人口的健康收益权重应约为最富裕的20%人口健康收益权重的6倍。 我们的研究表明，为乌干达人口改编此类问卷是可行的，并且这种方法可用于衡量其他环境下公众对健康不平等的厌恶程度。所引出的不平等厌恶参数可用于支持乌干达经济评估中对健康不平等影响的评估。