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Fair innings: An empirical test

Last registered on December 14, 2021
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Pre-Trial

Trial Information

General Information

Title
Fair innings: An empirical test
RCT ID
AEARCTR-0008694
Initial registration date
December 11, 2021

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
December 14, 2021, 4:35 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
France
Region

Primary Investigator

Name
Nicolas Treich
Affiliation
Toulouse School of Economics, INRAE
Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status
In development
Start date
2021-12-20
End date
2021-12-24
Keywords
Health, Welfare
Additional Keywords
Social choice, health economics, prioritarianism
JEL code(s)
I14, I31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
The main research objective is to test empirically the concept of “fair innings”, as introduced in Adler et al. (2021). This paper provides a rigorous basis in economic theory for the “fair innings” concept, proposed in the public health literature: as between an older individual and a similarly situated younger individual (one with the same income and risk profile), a risk reduction for the younger individual is accorded greater social weight even if the gains to expected lifetime utility are equal.

Adler M, Ferranna M, Hammitt JK and Treich N. « Fair innings? The utilitarian and prioritarian value of risk reduction over a whole lifetime », 2021, Journal of Health Economics 75, 102412.
External Link(s)

Registration Citation

Citation
Treich, Nicolas. 2021. "Fair innings: An empirical test." AEA RCT Registry. December 14. https://doi.org/10.1257/rct.8694-1.1
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
We use a survey questionnaire in which we elicit participants’ choices regarding some ethical decisions in the domain of public health. More precisely, we ask participants to consider a choice situation of the following type: “Two patients need a treatment to survive, but there is only one treatment. The patients differ only in terms of their age: one patient is 40 years old and the other is 60 years old. They both would live an extra 20 years with the treatment, and die immediately without the treatment. Which patient should receive the treatment?”. We then vary the numbers (years and duration) in the questions, and we also introduce uncertainty regarding the efficacy of the treatment and survival hances as well as changes in income and health levels.
Intervention Start Date
2021-12-20
Intervention End Date
2021-12-24

Primary Outcomes

Primary Outcomes (end points)
"Fair innings" scores
Primary Outcomes (explanation)
We plan to use two fair innings scores:
1) Proportion of questions where the respondent answers consistent with the fair innings motive
2) Fair innings intensity, namely an elicited measure of the extra years lived by the young that would be equivalent to a specific number of years lived by the old

Secondary Outcomes

Secondary Outcomes (end points)
A "prioritarianism" score
Secondary Outcomes (explanation)
To construct a prioritarianism score, we will ask respondents how much they agree or disagree (likert scale) with a list of statements which are informative about whether the respondents display prioritarian social preferences

Experimental Design

Experimental Design
We use a survey questionnaire in which we elicit participants’ choices regarding some ethical decisions in the domain of public health. More precisely, we ask participants to consider a choice situation of the following type: “Two patients need a treatment to survive, but there is only one treatment. The patients differ only in terms of their age: one patient is 40 years old and the other is 60 years old. They both would live an extra 20 years with the treatment, and die immediately without the treatment. Which patient should receive the treatment?”. We then vary the numbers (years and duration) in the questions, and we also introduce uncertainty regarding the efficacy of the treatment and survival chances as well as changes in income and health levels.
Experimental Design Details
We use a survey questionnaire in which we elicit participants’ choices regarding some ethical decisions in the domain of public health. More precisely, we ask participants to consider a choice situation of the following type: “Two patients need a treatment to survive, but there is only one treatment. The patients differ only in terms of their age: one patient is 40 years old and the other is 60 years old. They both would live an extra 20 years with the treatment, and die immediately without the treatment. Which patient should receive the treatment?”. We then vary the numbers (years and duration) in the questions, and we also introduce uncertainty regarding the efficacy of the treatment and survival chances as well as changes in income and health levels.
Randomization Method
We do not randomize participants. We randomize some questions in the questionnaire. Randomization is done by a computer.
Randomization Unit
No randomization of participants.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
N/A
Sample size: planned number of observations
N/A
Sample size (or number of clusters) by treatment arms
2000 respondents
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Toulouse School of Economics Research Ethics Committee for Experimental Research
IRB Approval Date
2021-12-10
IRB Approval Number
N/A
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
January 14, 2022, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
January 14, 2023, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
N=2144
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
No

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Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
The fair innings principle states that fairness requires allocating life‐saving treatments to younger
rather than older patients when each would gain the same extension in longevity. It is motivated by
the notion that older patients have already benefited from a longer life and so have less claim to
scarce treatment resources than younger patients who have not yet lived their “fair innings.” The
principle can be theoretically justified by a prioritarian social welfare function applied to lifetime
wellbeing. We conducted an online survey to test whether there is support for the principle in the
general population (in France). We find substantial but not universal support. When choosing to
allocate a treatment that would provide the same life extension to an older or younger patient,
about 40 to 55 percent of respondents would allocate the treatment to the younger patient while
about 30 to 35 percent are indifferent to which patient is treated. Holding the life extension to the
older patient fixed, increasing (decreasing) the life extension to the younger patient increases
(decreases) the fraction of respondents that would allocate treatment to the younger patient. These
results highlight the tension between principles of equal treatment and giving priority to those who
are worse off that confound healthcare policy.
Citation
Matthew D. Adler, Maddalena Ferranna, James K. Hammitt, Eugénie de Laubier, and Nicolas Treich (2023) Fair Innings: An Empirical Test, working paper.
URL
https://drive.google.com/file/d/1C5vtNxqz5mjnrOtLcJaF_t4Bc1_u-V9y/view

Reports & Other Materials