What is a Fair Innings? Preferences for Prioritisation by Age and Health

Abstract

The fair innings principle prioritises healthcare for patients who are younger or who would have fewer quality-adjusted life years (QALYs) without treatment. We gauge support for different interpretations and intensities of this prioritisation in a United Kingdom general public sample (n = 230). We use a novel localised convex budget set experiment (observations = 20,700) to estimate participant-specific parameters of social welfare functions (SWFs). There is overwhelming support for the principle, broadly defined. Prioritarian SWFs, with continuously diminishing marginal welfare from QALYs, fit the data of most participants better than linear SWFs with age weights, or than SWFs that are linear in QALYs up to a fair innings threshold at which there is a downward discontinuity in marginal welfare. We use the estimated parameters to obtain welfare weights by quality-adjusted life expectancy and illustrate their policy consequences. We compare our results with other justifications of age-based weighting in health policy decisions.

Joint paper with Owen O’Donnell, Erik Schokkaert, and Tom Van Ourti.