Abstract
Background
The United Kingdom is experiencing worrying trends in population health. Policy needs to shift ‘upstream’ to address fundamental causes. Universal Basic Income has emerged as one response to tackling these health issues. A Universal Basic Income would provide a new form of societal safety net through a regular, unconditional cash payment to all individuals in society. However, with scarce public resources and competing upstream income-based policies, such as a Minimum Income Guarantee, implementing transformative initiatives, such as Universal Basic Income, without a public mandate is unlikely. Currently, we do not know the extent to which the general public value different income-based policies, including when wider impacts, such as health outcomes, are explicitly stated.
Objective
This feasibility study had two broad aims. First, to determine which income-based policies to select for valuation, based on their importance to stakeholders and coverage of a range of characteristics and outcomes; second, to design and test a framework, and associated methods, for stated preference elicitation.
Design and methods
Six income-based policy scenarios – Universal Basic Income, Minimum Income Guarantee, Negative Income Tax, Participation Income, Targeted Basic Income and Universal Credit – were identified and developed through literature searches, stakeholder interviews (
n
= 13) and consultation with our General Public Panel. Policy scenarios were described in terms of five policy characteristics and impact described qualitatively based on three outcomes – overall population health, health inequality and income inequality. Three trade-off-based stated preference methods – choice, ranking and willingness to pay – were used to elicit preferences. All methods adopted a socially inclusive perspective. Think-aloud and open-ended interview questions were asked to explore respondents’ understanding of the survey methods and explore the reasons for respondents’ decisions.
Participants
For the main survey, 50 members of the general public were sampled across Glasgow and Newcastle using recruitment targets for age, gender, education, income, employment status, ethnicity, benefits, voting preferences and health status.
Results
Respondents understood the policy scenarios, the perspective they were asked to adopt when constructing their values and the task they were asked to complete in each of the survey methods. Relatively few respondents had fully inconsistent preferences, there was no evidence of a labelling effect and introducing information on outcomes did not impact preferences. The type of policy seems to matter, with respondents making trade-offs between policy type and the outcomes of improving overall health, health inequalities and/or income inequalities; there is also evidence of preference heterogeneity.
Limitations
Our small sample precludes claims about the generalisability of the findings. We focused on a subset of policy characteristics, outcomes were described qualitatively across three levels and the size of the monetary payments from the policies was not explicitly stated.
Conclusions
Overall, results suggest it is feasible to elicit public preferences for income-based policies with different policy characteristics when health and non-health outcomes are made explicit, using trade-off-based stated preference questions.
Future work
This feasibility study has laid the groundwork for a larger, nationally representative study that could provide much-needed new insights to inform policymaking around implementing transformative policies for tackling health inequalities.
Funding
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR153096.