Comparison of Equity Preferences for Life Expectancy Gains: A Discrete Choice Experiment among the Japanese and Korean General Public

Background: Setting priorities for limited public resources has become a topic of heated discussion the world over. Assigning different weights for the health gains of different population groups allows for equity considerations in cost-effectiveness analysis. However, only a few empirical works have elicited the preferences of the general public. Objective: To compare the equity preferemce assigned by Japanese and Koreans. Methods: We conducted a Web-based survey in March 2013, including a discrete choice experiment, to elicit the equity preferences of the general public for the life expectancy gains of different population groups. We selected attributes and designed the experiment following Norman et al.'s study (Norman R, Hall J, Street D, Viney R. Efficiency and equity: a stated preference approach. Health Econ 2013;22:568–81). Accordingly, we analyzed preference for sex, smoking status, lifestyle, caring status, income, and age. Results: The Japanese assigned a higher preference for males (P < 0.001), nonsmokers (P < 0.001), those with lower income (P < 0.001), and carers (P < 0.001), and they assigned a lower preference for those with a life expectancy of 60 years (P = 0.002) and 75-year-olds (P < 0.001). Koreans have the same patterns of preference for lower income (P < 0.001), caring (P < 0.001), and smoking status (P = 0.026). However, they prefer both sexes (P = 0.331) and different age groups equally. In both countries, respondents tend to prefer groups with characteristics similar to their own. Conclusions: People from the two Asian developed countries, with universal health insurance, show different equity preferences. These may reflect the variations in cultural background and coverage of health care services.