The Allocation of Scarce Resources: Social Housing

Article excerpt

Previous studies on the allocation of scarce medical resources have shown that certain patient variables (e.g. sex, age, number of dependants) significantly affect lay participants' rank ordering of them for costly treatment. This study replicates the methodology of these studies (Furnham, Meader, & McClelland, 1999, Furnham, Simmons, & McClelland, 2000) but using allocation to social housing as the dependent variable. One hundred and sixty-three adults rank ordered sixteen people to be allocated a flat from a housing list. The results indicated that whereas gender made no difference in the decision, nonsmokers were favored over smokers, the mentally healthy over the mentally ill; and those with average intelligence over those with high intelligence. These results are comparable to those from studies looking at the allocation of scarce medical resources.

For self-evident reasons there is a rich medical and ethical literature from many countries on the appropriate allocation of scarce medical resources (Brody, 1981; Charlesworth, 1993; Freund, 1971; Koch, 1996; Lamb, 1989; Le Grand, 1991). There is an extensive psychological literature on distributive justice which is concerned with resource distribution (Deutsch, 1975; Greenberg, 2001) as well as an important philosophical literature on justice theories (Rawls, 1971). More recently there is an empirical psychological literature on the allocation of medical resources (Furnham, 1996; Furnham & Briggs, 1993; Furnham, Meader, & McClelland, 1999; Furnham & Ofstein, 1997; Furnham, Simmons, & McClelland, 2000; Furnham, Thomas, & Petrides, 2002).

Charles worth (1993) has argued that ethical values play a part at every level of the allocation process, namely, governmental, institutional, clinical unit and individual. Brody (1981) spelt out five slightly different principles that may be used to make allocation decisions: 1. Who merits or deserves it the most; 2. Who has contributed the most to society; 3. Who has the greatest ability to pay - in money or in other goods desired in the marketplace; 4. Who needs it the most; 5. Similar treatment for similar cases.

Furnham and colleagues (Furnham, 1996; Furnham & Briggs, 1993; Furnham, Hassomal, & McClelland, 2002; Furnham, Meader, & McClelland, 1999; Furnham & Ofstein, 1997; Furnham, Simmons, & McClelland, 2000; Furnham, Thomas, & Petrides, 2002) and others (Murphy-Berman, Herman, & Campbell, 1998) have empirically investigated the factors which influence people's judgment when they are asked to choose between medically equivalent patients. This research has stimulated PhD researchers to look at public conceptions of distributive justice in health care (Reeves, 2000). The studies all involved a very similar methodology where participants are provided with a questionnaire containing minimal demographic information on a list of candidates for a kidney machine or other specific medical treatment (Furnham, Thomson, & McClelland, 2002). Participants are instructed to select the one candidate they believe should receive treatment on the kidney machine (or some other technology) and then rank the remaining candidates in order of priority to receive treatment.

A number of variables were found to have a significant effect on participants' choices (See Table 1). The variables which showed the greatest effects were age, with younger patients favored over older patients (Furnham & Briggs, 1993) and number of dependants, with people with a larger number of dependants being favored over those with fewer or no dependants (Furnham & Briggs, 1993; Furnham & Ofstein, 1997). The effect of age is most likely to be related to prognosis. A younger patient is more likely to benefit from the treatment because he/she is likely to live longer than an older candidate. The effect of number of dependants is likely to be based on a utilitarian judgment. The benefits are greater if an individual with a family receives the treatment because the welfare of the individual's family enters the equation. …


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