HEALTH INEQUALITY AVERSION IN CHINA: PUBLIC AND DECISION-MAKER VIEWS
Author(s)
Xiaoning He, PhD1, Yuhang Xin, PhD2, Shitong Xie, PhD1, Jing Wu, PhD1, Richard Cookson, PhD3.
1Tianjin University, Tianjin, China, 2PhD Student, Tianjin University, Tianjin, China, 3University of York, York, United Kingdom.
1Tianjin University, Tianjin, China, 2PhD Student, Tianjin University, Tianjin, China, 3University of York, York, United Kingdom.
Presentation Documents
OBJECTIVES: This study compared preferences for health equity-efficiency trade-off between the Chinese general public and health policy decision-makers. We tested the hypothesis that institutional role and professional identity shape distributive reasoning, leading to systematic differences in health inequality aversion.
METHODS: We conducted a cross-sectional survey using the validated Benefit Trade-Off (BTO) method to elicit the inequality aversion preferences. The study comprised a nationally representative sample of the general adult population (n=1,001), recruited via face-to-face interviews, and a purposive sample of senior officials from health policy institutions, specifically the healthcare security administration and the health commission (n=80). Preferences were classified into distinct categories (Pro-rich, Health Maximiser, Weighted Prioritarians, Maximin, and Egalitarians). Multivariable regression and subgroup analyses were employed to isolate the effect of stakeholder role from demographic and socioeconomic confounders.
RESULTS: Decision-makers' preference profiles differed markedly from the public's. They were significantly less likely to hold polarized views, with a 21% lower probability of being Pro-rich and a 27% lower probability of being Egalitarians. Conversely, they were 34% more likely to endorse the moderate, compromise-oriented Weighted Prioritarians position (all p<0.05). Statistical models indicated these gaps were primarily driven by institutional role identity. Furthermore, decision-makers spent substantially longer completing the BTO task (mean difference = 185 seconds, p < 0.001), indicating more effortful and deliberative reasoning.
CONCLUSIONS: A significant divide exists in distributive reasoning. The public leans toward intuitive, value-polarized preferences, whereas health decision-makers engage in slower, pragmatic evaluations, favoring balanced trade-offs. For health policy, these findings highlight the value of integrating public normative values with the deliberate, pragmatic perspectives of institutional decision-makers to inform resource allocation.
METHODS: We conducted a cross-sectional survey using the validated Benefit Trade-Off (BTO) method to elicit the inequality aversion preferences. The study comprised a nationally representative sample of the general adult population (n=1,001), recruited via face-to-face interviews, and a purposive sample of senior officials from health policy institutions, specifically the healthcare security administration and the health commission (n=80). Preferences were classified into distinct categories (Pro-rich, Health Maximiser, Weighted Prioritarians, Maximin, and Egalitarians). Multivariable regression and subgroup analyses were employed to isolate the effect of stakeholder role from demographic and socioeconomic confounders.
RESULTS: Decision-makers' preference profiles differed markedly from the public's. They were significantly less likely to hold polarized views, with a 21% lower probability of being Pro-rich and a 27% lower probability of being Egalitarians. Conversely, they were 34% more likely to endorse the moderate, compromise-oriented Weighted Prioritarians position (all p<0.05). Statistical models indicated these gaps were primarily driven by institutional role identity. Furthermore, decision-makers spent substantially longer completing the BTO task (mean difference = 185 seconds, p < 0.001), indicating more effortful and deliberative reasoning.
CONCLUSIONS: A significant divide exists in distributive reasoning. The public leans toward intuitive, value-polarized preferences, whereas health decision-makers engage in slower, pragmatic evaluations, favoring balanced trade-offs. For health policy, these findings highlight the value of integrating public normative values with the deliberate, pragmatic perspectives of institutional decision-makers to inform resource allocation.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR161
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
No Additional Disease & Conditions/Specialized Treatment Areas