The Effect of Framing on Preferences for Equality

A common assumption in health policy studies is QALY-maximization: Policies yielding greater QALYs are preferred to those yielding fewer QALYs. However, most empirical studies report aversion to inequality, or the desire to sacrifice some QALYs to obtain a more equal distribution of health in the population. Notably, studies to date present distributions of health as either proportion or total number of persons achieving a health state under different policies. This presentation frame obscures the key qualitative principle behind QALY-maximization: Those individuals unaffected by a policy choice should not influence policy choice. In the current paper, using a within-subjects experiment, we replicate the finding of inequality aversion under a frame standard in the literature, we then present choice problems under a new frame that makes explicit the individuals unaffected by a policy choice. We find that, under this new frame, inequality aversion is greatly reduced