Candidate for the Lee B. Lusted Student Prize Competition
Purpose: To assess both the estimated and ideal (preferred) distributions of health and healthcare of Americans, and compare each with the actual distribution of health and healthcare.
Methods: 415 Americans (58% female, age range: 18 to 74) estimated the distribution of outcomes for Americans in each of the five income quintiles in three domains of health and healthcare: a) mortality rates (total deaths between ages 35 to 36), b) unmet need for prescription medications (unable to obtain prescription medication due to cost in the previous year) and c) gains in life expectancy (average increase in the number of months people lived over the previous 20 years). Respondents also reported their ideal distributions of health and healthcare – how they thought health and healthcare should be distributed among Americans. These estimated and ideal distributions were then compared with the actual distributions of health and healthcare among the rich and poor. Responses were analyzed in aggregate and in subgroups stratified by political affiliation and income level.
Results: Respondents' estimated distributions of mortality rates and unmet need for prescription medications as a function of income were fairly accurate. However, respondents underestimated the extent to which gains in life expectancy was concentrated among the wealthy (p<0.05) and overestimated the extent to which gains in life expectancy were shared by the poor (p<0.05). Most importantly, estimated and ideal distributions differed significantly (p<0.05) on all three dimensions of health and healthcare – mortality rate, unmet need for prescription medications, and gain in life expectancy – such that respondents wanted these health outcomes to be spread more evenly among the rich and poor than they estimated them to be (see Figure 1 for actual, estimated, and ideal distributions of gains in life expectancy). Democrats and lower income respondents preferred more equal health distributions compared to Republicans and higher income respondents, respectively (p<0.05 for all the comparisons). However, all respondents – rich and poor, conservative and liberal – desired more equal distributions of health outcomes than the current actual distributions in the United States.
Conclusions: Estimated and ideal distributions of health and healthcare differ significantly, suggesting that Americans across the political and economic spectrum would prefer health and healthcare to be more equally distributed among the rich and poor.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making