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58:oral Incorporating concern for health equity into resource allocation decisions: development of a tool and population-based valuation for Uganda
  1. Fan Yang1,
  2. Kenneth Roger Katumba2,
  3. Giulia Greco2,3,
  4. Janet Seeley2,3,
  5. Eliabeth Ekirapa4,
  6. Paul Revill1,
  7. Susan Griffin1
  1. 1Centre for Health Economics, University of York, UK
  2. 2MRC/UVRI and LSHTM Uganda Research Unit, Uganda
  3. 3London School of Hygiene and Tropical Medicine, London, UK
  4. 4School of Public Health, Makerere University, Uganda


Health systems around the world aim to increase population health and to reduce health inequalities, but there are challenges in undertaking health economic analyses that simultaneously address these two concerns. Such analyses require information on whether the population support using healthcare resources to reduce health inequalities, and how much inequality reduction is valued relative to increase in total population health. Previous research has attempted to quantify this preference in the form of an inequality aversion parameter in a specified social welfare function. This study aimed to elicit general population’s views on health inequality, and to estimate an inequality aversion parameter in Uganda. Adult respondents from the general population were quota-sampled based on age and sex and recruited from the Central region in Uganda. The survey was adapted from an existing questionnaire, and included trade-off questions between two hypothetical healthcare programmes. Data on participants’ demographic and socioeconomic characteristics and health-related quality of life measured by EQ-5D-5L were collected. A nationally representative sample of 165 participants were included, with mean age of 37.1 years and mean EQ-5D-5L score at 0.836. The majority of respondents (79.4%) indicated willingness to trade-off some total population health to reduce health inequality. Translating the preferences into an Atkinson inequality aversion parameter (14.70) implies that health gain to the poorest 20% of people in Uganda should be given about 6 times the weight of health gains to the richest 20%. Our study suggests it is feasible to adapt questionnaires of this type for a Ugandan population, and reveals their strength of concern for health inequality. The results will enable the application of methods to integrate health inequality impacts into healthcare resource allocation and policy prioritisation in Uganda. This approach could be used to measure public aversion to health inequality in other settings.

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