OBJECTIVES: Novel approaches to economic evaluation seek to value improvements in health equity. These approaches use population preferences, often elicited from choice experiments, to weight health outcomes across equity domains or attributes. Few studies have sought to understand which attributes the general public prioritizes. We sought to understand the attitudes and beliefs of residents of Canada and the United States on valuing health equity. Results will aid in the design of future choice experiments to value health equity.

METHODS: We conducted online focus groups with residents of both countries. Participants were recruited online using a purposive sampling technique. Conversations focused on conceptions of fairness in health care and identifying equity-relevant attributes that respondents consider relevant to fair resource allocation decisions. Transcripts and notes were assessed in an iterative manner using a constant comparative technique.

RESULTS: 29 individuals in Canada and 27 in the US participated in the focus groups. Participants in both countries had similar views that a fair system is based on equality in access, where all individuals can access quality care and be treated equally regardless of their characteristics and circumstances. In the US, themes across focus groups were promoting universal access, affordability, and individual responsibility in health. In Canada, common themes included promoting universality, accessibility, particularly in rural areas, and reduced wait times. Improved access was often considered more important than efforts to achieve similar health outcomes. Discussions highlighted the importance of framing questions of health equity. When asked about allocating resources, respondents were unwilling to use characteristics such as race, ethnicity, or gender in determining equitable allocations. Yet, these characteristics were often cited as important to consider when identifying disparities to address.

CONCLUSIONS: Future choice experiments to value improvements to health equity must carefully consider how respondents conceptualize equity regarding the allocation of health care resources.