Citizen's Preferences Regarding Principles to Guide Health-Care Allocation Decisions in Thailand

Objectives: The objective of this study was to investigate the extent to which five principles of rationing (lottery, rule of rescue, health maximization, fair innings, and choicism) were preferred by a sample of Thai citizens for selecting patients to receive high-cost therapies. Methods: A self-administered survey was used for collecting data from a sample of 1000 individuals living in Thailand. Descriptive statistics, factor analysis, and multinomial logistic regression analysis were used for describing and validating the data. Out of the 1000 sample members, 780 (78%) provided usable responses. Results: The results showed that within specific situations under budget constraints, Thai people used each of the criteria we studied to ration health care including: 1) lottery principle; 2) rule of rescue; 3) health maximization; 4) fair innings; and 5) choicism. Conclusions: The extent to which the criteria were applied depended on the specific situation placed before the decision-maker. "Choicism" (equalizing opportunity for health) was the most preferred method for rationing when compared to each of the other four principles.