Age-based equitable health resource allocation and the fair innings argument

The paper addresses the efficient and fair allocation of limited healthcare resources to patient groups, with a special focus on the consideration of patients’ age in the allocation decision. At the core of this issue lies the controversially discussed “fair innings argument” which suggests a prioritization of younger patients over older ones. Recently, Adler (J Health Econ 75:102412, 2021) developed a rigorous theoretical framework for the fair innings concept, building on a prioritarian social welfare function. The first goal of the present work is to recast this prioritarian framework to an egalitarian one by employing a social welfare function based on the Gini index. Some theoretical properties related to the “social value of risk reduction” are derived. Secondly, as an example of application, it is shown how the egalitarian framework can be used to set up an optimization model for vaccination policies against epidemics. Third, an alternative for healthcare decision makers who reject the fair innings argument is offered by proposing a variant of the egalitarian model which builds on the idea of “deontic fairness” by Parfit (Equality or priority?, University of Kansas, Lawrence, 1995). Numerical results on a small case study are presented and compared.