Healthy self-interest? Health dependent preferences for fairer health care

Antonini, Marcello ORCID: 0000-0001-5816-2289 and Costa-Font, Joan ORCID: 0000-0001-7174-7919 (2025) Healthy self-interest? Health dependent preferences for fairer health care. Journal of Economic Behavior & Organization, 240. ISSN 0167-2681

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Abstract

Health status can alter individuals’ social preferences, and specifically individuals' preferences regarding fairness in the access to and financing of health care. If individuals follow a healthy self-interested rationale, health improvements are expected to weaken individuals' support for fairer health care financing and access, as they perceive reduced need for healthcare services. Conversely, if healthier people face a higher opportunity cost of deteriorating health, they may endorse fairer financing and access in anticipation of future health challenges—which we label as the 'unhealthy self-interest' hypothesis. We draw on a dataset of 73,452 individuals across 22 countries and a novel instrumental variable strategy that exploits variation in health status resulting from cross-country exposure to the national childhood Bacillus Calmette–Guérin (BCG) vaccination schedules. We document causal evidence consistent with the unhealthy self-interest hypothesis, which indicates that better health increases preferences for a fairer health care system. We estimate that a one-unit increase in self-reported health increases support for fair health care access by 11% and the willingness to support fair financing by 8%. Our findings suggest that improving population health, they may give rise to stronger support for interventions to improve equitable health system access and financing.

Item Type:	Article
Additional Information:	© 2025 The Author(s)
Divisions:	Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine H Social Sciences > HV Social pathology. Social and public welfare. Criminology
JEL classification:	I - Health, Education, and Welfare > I3 - Welfare and Poverty > I38 - Government Policy; Provision and Effects of Welfare Programs
Date Deposited:	10 Nov 2025 11:12
Last Modified:	01 Dec 2025 04:22
URI:	http://eprints.lse.ac.uk/id/eprint/130090

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