Fang Nan, Su Chang, Wu Jing
School of Pharmaceutical Science and Technology, Faculty of Medicine, Tianjin University, Tianjin 300072, China.
Centre for Social Science Survey and Data, Tianjin University, Tianjin 300072, China.
Healthcare (Basel). 2025 May 30;13(11):1309. doi: 10.3390/healthcare13111309.
BACKGROUND/OBJECTIVES: While a preference for an equal distribution of health gains is common, there are situations where individuals may opt to concentrate health gains for a select few. This study investigates how distributive preferences, defined as societal valuations of alternative allocations of fixed total health benefits, vary with the magnitude of individual health gains.
Using the person trade-off (PTO) method, we conducted an online survey with a nationally representative sample of Chinese adults (N = 500). The respondents evaluated five allocation programs differing in both individual health gain magnitude and number of beneficiaries. Distributive preferences are classified into five distinct types: diffusion, concentration, maximization, extreme egalitarianism and extreme inequality seeking. Threshold regression analysis identified critical transition points in preference patterns.
Non-maximizing tendencies were dominant (79% of the respondents). The health gain threshold was estimated to be 4.6 years (95% CI: [4.28, 4.85]): below this threshold, respondents tend to allocate smaller benefits to more patients (diffusion preference); above the threshold, people are inclined to allocate larger benefits to fewer patients (concentration preference). The income level and self-reported health status of the participants were identified as potential factors influencing distributive preferences.
This study provides the first quantitative evidence from China that distributive preferences exhibit a non-linear shift based on the magnitude of health benefits. The identified 4.6-year threshold provides policymakers with an empirically based instrument to strike a balance between efficiency and the reduction in inequality in resource allocation. These findings advocate for incorporating social value weights into health technology assessments, especially for interventions that offer substantial individual benefits.
背景/目的：虽然人们普遍倾向于健康收益的平等分配，但在某些情况下，个人可能会选择将健康收益集中于少数人。本研究调查了分配偏好（定义为对固定总健康效益的替代分配的社会估值）如何随个人健康收益的大小而变化。
我们采用个人权衡（PTO）方法，对具有全国代表性的中国成年人样本（N = 500）进行了在线调查。受访者评估了五个在个人健康收益大小和受益人数方面都不同的分配方案。分配偏好被分为五种不同类型：扩散型、集中型、最大化型、极端平等主义型和极端不平等寻求型。阈值回归分析确定了偏好模式中的关键转变点。
非最大化倾向占主导（79%的受访者）。健康收益阈值估计为4.6年（95%置信区间：[4.28, 4.85]）：低于此阈值时，受访者倾向于将较小的收益分配给更多患者（扩散偏好）；高于此阈值时，人们倾向于将较大的收益分配给较少患者（集中偏好）。参与者的收入水平和自我报告的健康状况被确定为影响分配偏好的潜在因素。
本研究提供了来自中国的首个定量证据，表明分配偏好会根据健康效益的大小呈现非线性转变。确定的4.6年阈值为政策制定者提供了一种基于实证的工具，以在资源分配的效率和不平等减少之间取得平衡。这些发现主张将社会价值权重纳入健康技术评估，特别是对于能带来大量个人效益的干预措施。
