Attribute framing affects the perceived fairness of health care allocation principles
Abstract (Via Gamliel & Peer SJDM)
Health care resource allocation is a central moral issue in health policy, and opinions about it have been studied extensively. Allocation situations have typically been described and presented in a positive manner (i.e., who should receive medical aid). On the other hand, the negative valence allocation situation (i.e., who should not receive medical aid) has been relatively neglected. This paper demonstrates how positive versus negative framing of the exact same health care resource allocation situation can affect the perceived fairness of allocation principles. Participants usually perceived non-egalitarian principles (i.e., need, equity and tenure) to be fairer in positively framed situations (i.e., to deliver health care resources to certain patients) than negatively framed situation (i.e., not to deliver health care resources to other patients). However, framing did not affect the perceived fairness of the equality principle (i.e., a random draw). The paper offers a theoretical explanation for the effect of framing on the perceived fairness of health care resource allocation and discusses implications for both researchers and policy makers.
Introduction (Via Gamleile & Peer SDJM)
The issue of allocating health care resources to recipients is a central medical and ethical concern (Cuadras-Morató, Pinto-Prades, & Abellán-Perpiñán, 2001; Moore, 1996). Patients in need of medical aid frequently rely on the generosity of their community for survival. However, a community usually has a finite amount of health careresources, and the question of how these lifesaving but scarce health care resources should be distributed has been studied extensively (e.g., Ubel, Baron, Nash, & Asch, 2000; Ubel & Lowenstein, 1996).
As can be expected, the just allocation of social resources occupies many scholars, and different theories advocate different allocation principles. (For a taxonomy of distributive justice theories, see Sabbagh, 2001.) In the normative tradition of Miller’s Theory of Justice (Miller, 1976) and the multiprinciple approach (Deutsch, 1985; Törnblom, 1992), three principles have usually been identified as central to the concept of distributive justice: equity, equality and need.