Eliciting people's preferences for the distribution of health: A procedure for a more precise estimation of distributional weights

In order to incorporate distributional concerns into cost-effectiveness analysis, it would be useful to elicit distributional weights that express people's valuation of marginal health gains at various levels of health. Distributional preferences are commonly elicited either through a person trade off (PTO) or a gain trade off (GTO) technique. An inherent problem of the GTO is that it is based on the valuation of non-marginal health gains. In practice, many contributions using the PTO also focus on non-marginal health gains. This paper demonstrates that the failure to distinguish appropriately between marginal and non-marginal health gains may lead to seriously misleading estimates of distributional weights. Moreover, the paper proposes a methodology for utilising information obtained through non-marginal analysis more efficiently in order to obtain more reliable estimates of distributional weights. The methodology was successfully applied in an empirical study of age weights.Health equity Distributional weights Eliciting preferences