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  1. Distributional dilemmas in health policy : large benefits for a few or smaller benefits for many ?

    Article - En anglais


    To examine funding priorities assigned by health ministry officials when choosing between clinical programs that offer similar overall benefits distributed in different ways (e.g. large gains for a few versus small gains for many), and to compare the relative magnitude of any distributional bias to age biases.


    A survey consisting of paired hypothetical health care programs was mailed to the 135 most senior officials of the Health Ministry in Ontario, Canada (population 11.5 million).

    Respondents were asked to assume they were members of a panel allocating a fixed sum of money to one of two programs in each pair.

    All program descriptions included the number of persons affected each year by a given disease and the average survival gains from the hypothetical programs.

    Some scenarios also mentioned the side-effects associated with programs and/or the average age of the beneficiaries.


    Four respondents had retired/died.

    Of 131 eligible respondents, 80/131 (61%) provided usable responses.

    Asked to choose between providing large benefits to a few citizens and small benefits to a great many, 23% (95% CI : 14%, 33%) of respondents were unable to decide, but 55,8% (95% CI : 47%, 70%) favored providing large benefits to fewer patients.

    Eliminating the 23% unable to decide, 47/62 or 76% (CI : 63%, 86%) expressed a distributional preference. (...)

    Mots-clés Pascal : Canada, Amérique du Nord, Amérique, Monde, Protection sociale, Evaluation, Méthodologie, Aspect politique, Géographie, Financement, Système santé

    Mots-clés Pascal anglais : Canada, North America, America, World, Welfare aids, Evaluation, Methodology, Political aspect, Geography, Financing, Health system

    Logo du centre Notice produite par :
    Observatoire Régional de la Santé Auvergne-Rhône-Alpes

    Code Inist : 002B30A11. Création : 21/07/1998.