Health Inequality Aversion in the United States and Americans' Views on Health Inequality
Author(s)
Julia F. Slejko, PhD1, Salome Ricci, MS, PharmD2, Susan Dosreis, PhD2, Stacey Kowal, BS, MSc3;
1University of Maryland School of Pharmacy, Associate Professor, Baltimore, MD, USA, 2University of Maryland School of Pharmacy, Baltimore, MD, USA, 3Genentech, South San Francisco, CA, USA
1University of Maryland School of Pharmacy, Associate Professor, Baltimore, MD, USA, 2University of Maryland School of Pharmacy, Baltimore, MD, USA, 3Genentech, South San Francisco, CA, USA
OBJECTIVES: Americans’ views on health inequalities have largely been ignored when evaluating the distribution of healthcare resources. Considering the importance of this topic in United States’ (US) politics, our study examined political party affiliation and views on health equity in the US.
METHODS: We adapted an established benefit trade-off (BTO) instrument to elicit health inequality aversion among the US adult general public from June - December 2023. We administered the BTO and survey questions on demographics, political affiliation, and health inequalities using an online platform. Questions were framed around US population groups described as ‘Better Off’, ‘Worse Off’, or ‘Middle’, in terms of length/quality of life and geographic social vulnerability. BTO responses were analyzed to calculate Atkinson parameters. Parameters >0 reflect ‘health inequality aversion’, or the willingness to sacrifice efficiency to improve equality. Survey responses were summarized using descriptive statistics. We compared views and proportion inequality averse across the US population groups using Chi-squared tests.
RESULTS: Among 1,290 respondents, political affiliation was: Republican 26% (n=339), Democrat 37% (n=471), Independent/Unaffiliated 35% (n=452), Unreported 2% (n=28). Most respondents agreed/strongly-agreed with reducing health inequality between Americans and with having an equal opportunity to be healthy, although there were higher proportions agreeing/strongly-agreeing among Democrats/Independents. The percent of the population inequality averse significantly differed (p<0.01) by political affiliation: Republican (78%), Democrat (94%), Independent/Unaffiliated (90%). Although 94% of respondents agreed that improving the health of the American people should be a priority for the federal government (87% of Republicans, 99% of Democrats, 93% of Independent/Unaffiliated), only 45% would pay more taxes to address health inequalities (27% of Republicans, 61% of Democrats, 42% of Independent/Unaffiliated).
CONCLUSIONS: While the general US population is largely inequality averse, the greatest difference in views on health equity between political parties pertained to government’s role in funding efforts to reduce health inequalities.
METHODS: We adapted an established benefit trade-off (BTO) instrument to elicit health inequality aversion among the US adult general public from June - December 2023. We administered the BTO and survey questions on demographics, political affiliation, and health inequalities using an online platform. Questions were framed around US population groups described as ‘Better Off’, ‘Worse Off’, or ‘Middle’, in terms of length/quality of life and geographic social vulnerability. BTO responses were analyzed to calculate Atkinson parameters. Parameters >0 reflect ‘health inequality aversion’, or the willingness to sacrifice efficiency to improve equality. Survey responses were summarized using descriptive statistics. We compared views and proportion inequality averse across the US population groups using Chi-squared tests.
RESULTS: Among 1,290 respondents, political affiliation was: Republican 26% (n=339), Democrat 37% (n=471), Independent/Unaffiliated 35% (n=452), Unreported 2% (n=28). Most respondents agreed/strongly-agreed with reducing health inequality between Americans and with having an equal opportunity to be healthy, although there were higher proportions agreeing/strongly-agreeing among Democrats/Independents. The percent of the population inequality averse significantly differed (p<0.01) by political affiliation: Republican (78%), Democrat (94%), Independent/Unaffiliated (90%). Although 94% of respondents agreed that improving the health of the American people should be a priority for the federal government (87% of Republicans, 99% of Democrats, 93% of Independent/Unaffiliated), only 45% would pay more taxes to address health inequalities (27% of Republicans, 61% of Democrats, 42% of Independent/Unaffiliated).
CONCLUSIONS: While the general US population is largely inequality averse, the greatest difference in views on health equity between political parties pertained to government’s role in funding efforts to reduce health inequalities.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P17
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Insurance Systems & National Health Care, Pricing Policy & Schemes, Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas