Wait for others?: Social and intertemporal preferences in allocation of healthcare resources

Every day, people make decisions that involve allocating scarce resources like time or money to one use or another. Such decisions may come with different consequences for others (social preferences) and for the future (intertemporal preferences). So far, research regarding the effect of peoples’ social and intertemporal preferences on their decision making have remained largely separate. In this thesis, the joint effect of these preferences on allocation decisions is studied. The focus in these studies is on decision making in the healthcare domain. This is an interesting and relevant domain for studying social and intertemporal preferences because in most countries the budget for healthcare is limited and, therefore, decisions have to be made about how to spend this budget. Decisions about who receives treatment and when may of course have significant temporal and social consequences. All in all, using a variety of methods for collecting and analyzing data across the four chapters, this thesis shows that social preferences seem to have a stronger effect on decision making in the health care context than intertemporal preferences. Moreover, while there is considerable difference in preferences between people participating in the studies, a part of them is purely selfish in their choice behavior while another part seems more motivated by inequity aversion. This heterogeneity poses a challenge for policy makers. Targeted policies and communication strategies will be required to achieve behavioral change or public support for policies in the majority of the population

Preferences for investment in and allocation of additional healthcare capacity

Policy makers need to make decisions regarding the allocation of scarce healthcare resources. We study preferences for investment in additional healthcare capacity and allocation between two regions, focusing on reducing waiting time for elective surgery for a physical health problem. We elicit preferences from a societal and an individual perspective, with unequal initial waiting times between the two regions. In an online survey, 1039 respondents were randomly assigned to one of three versions of the experiment: (1) a social planner perspective, placing respondents in the role of a policy maker; (2) an individual perspective where the respondent's own region was better off regarding initial waiting times; (3) an individual perspective where the individual's own region was worse off regarding initial waiting times. Respondents were asked to rank the status quo and five scenarios where the investment in additional capacity led to different distributions of shorter waiting times between regions. For all allocations we presented both the reduction in waiting time and the resulting final waiting time for both regions. We find that in version 1 of the experiment, preferences were in line with inequality aversion and Rawlsian preferences regarding final waiting time. In version 3, similar preferences were found, although here they also align with individualistic preferences. In version 2, preferences were more heterogeneous, with both individualistic and egalitarian preferences present. Concluding, individualistic and egalitarian preferences mostly concerned final waiting time. We therefore recommend policy makers to focus on the effect on final waiting time instead of the reduction of waiting time