Grouping Promotes Equality: The Effect of Recipient Grouping on Allocation of Limited Medical Resources

Abstract

Decisions about allocation of scarce resources, such as transplant organs, often entail a trade-off between efficiency (i.e., maximizing the total benefit) and fairness (i.e., dividing resources equally). In three studies, we used a hypothetical scenario for transplant-organ allocation to examine allocation to groups versus individuals. Study 1 demonstrated that allocation to individuals is more efficient than allocation to groups. Study 2 identified a factor that triggers the use of fairness over efficiency: presenting the beneficiaries as one arbitrary group rather than two. Specifically, when beneficiaries were presented as one group, policymakers tended to allocate resources efficiently, maximizing total benefit. However, when beneficiaries were divided into two arbitrary groups (by hospital name), policymakers divided resources more equally across the groups, sacrificing efficiency. Study 3 replicated this effect using a redundant attribute (prognosis) to create groups and found evidence for a mediator of the grouping effect—the use of individualizing information to rationalize a more equitable allocation decision.