Is an ounce of prevention worth a pound of cure? Comparing demand for public prevention and treatment policies

Abstract

Background. Public policy can affect the allocation of resources between programs designed to prevent illnesses or injuries and programs designed to treat those who are already sick or injured. Information about preferences for treatment and prevention policies can help policy makers more effectively allocate public health resources among alternative uses. Our objective is to assess preferences for publicly funded health policies designed to prevent or treat major health threats. We use national surveys that employ discrete choice experiment formats. The surveys allow respondents to make trade-offs between policies designed to prevent or treat most major health threats. The surveys were administered to a nationally representative sample of over 3000 respondents. Methods. We estimate a random utility model of preferences for treatment and prevention policies and explore sources of systematic heterogeneity in preferences. Results. We estimate marginal utility associated with avoided deaths to be about twice as high for prevention policies as for treatment policies and find statistically significant heterogeneity with respect to disease type, the group targeted by the policy, and respondent characteristics. Conclusions. Preferences for public health policies vary markedly with policy attributes and with individual characteristics. Benefits measurements for welfare assessments of public health policies should be tailored to the type of health threat and the characteristics of the affected population.