SPREADING THE HEALTHCARE: THAIS' ESTIMATED VERSUS IDEAL DISTRIBUTIONS OF GOVERNMENTAL HEALTHCARE SPENDING

Saturday, January 9, 2016: 12:15
Kai Chong Tong Auditorium, G/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

Sorapop Kiatpongsan, MD, PhD, Chulalongkorn University, Bangkok, Thailand, Krittinee Nuttavuthisit, PhD, Sasin Graduate Institute of Business Administration of Chulalongkorn University, Bangkok, Thailand and Michael I. Norton, PhD, Harvard Business School, Boston, MA

Purpose:

To compare Thais' estimated and ideal distributions of governmental spending on healthcare services for the rich and poor.

 

Method(s):

The survey was conducted by face-to-face interviews in Thailand from February to April 2015. A nationally representative, probability-based, random sample of Thais (N = 3,500) was asked to estimate the distribution of governmental spending on healthcare services for Thais in each of the five income quintiles. Respondents then reported their ideal distributions: how they thought the government should allocate healthcare spending to rich and poor Thais.

We compared estimated and ideal distributions to each other, and to the actual distributions of healthcare spending for the rich and poor. We focused our analyses on government healthcare spending on the richest (top 20%) and poorest (bottom 20%) groups.

Results were analyzed in aggregate and stratified by participants' gender, age, education, and income. Statistical significance was determined at p < 0.05.

 

Result(s):

Three thousand and five hundred participants completed the interviews. The response rate was 72.4% (3,500 out of 4,833). Mean age was 41.1 years and half of participants (50.8%) were female.

Respondents underestimated how much of the healthcare budget (i.e., proportion of total healthcare budget) was spent on the richest group (21.9% versus 54.8%) and preferred that a smaller proportion be used for the richest group than their estimate (12.0% versus 21.9%), p < 0.001 for both comparisons. Respondents overestimated how much of the healthcare budget was spent on the poorest group (21.1% versus 5.7%) and preferred that a larger proportion be used for the poorest group compared to their estimate (33.1% versus 21.1%), p < 0.001 for both comparisons. See Figure 1 for full results.

Importantly, respondents preferred that the government spend a significantly higher proportion of healthcare budget on the poorest group compared to the richest group (33.1% versus 12.0%), p < 0.001 – the exact opposite pattern of current spending on the poorest (5.7%) and richest (54.8%).

We found similar results in all subgroup analyses regardless of respondents' gender, age, education and income.

 

Conclusion(s):

Thais underestimate the disparities in governmental healthcare spending on the rich and poor. They prefer that the government allocate a higher proportion of healthcare budget to the poor and that the proportion for the poor is larger than the proportion for the rich.

 

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