An explorative study of "preferred" health care decision rules

Priority setting in health care under conventional rules of health economic evaluation is based upon the ethos of attempting to maximize post-treatment health gain given available health care resources. In his later years, Alan Williams advocated an alternative ‘overarching’ decision rule that was informed by egalitarian principles, which is known as the ‘fair innings argument’. The fair innings approach balances differences in whole lifetime experiences of health (the egalitarian concern) with differences in post-treatment outcomes (the efficiency concern) when prioritizing people for health care. This article reports a study that presented respondents with a number of abstract health care decision contexts in an attempt to test, both quantitatively and qualitatively, the extent to which post-treatment health maximization, the fair innings argument, or, indeed other ‘decision rules’, are evident in the respondents’ answers. The results indicate that the most commonly observed decision rule differs substantially across health care contexts, possibly because underlying ‘values’ are context-dependent. Therefore, assuming that what individuals want has some relevance with respect to what policy-makers ought to do, the results of this study imply that rather than pursue an overarching decision rule, it may be more appropriate to vary the rule according to the particular health care decision context under consideration.