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Public Preferences Regarding Equitable Healthcare Rationing Across Gender Identities in China.

Chau-Kiu Cheung1, Zenan Wu1, Eileen Yuk-Ha Tsang1

  • 1Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China.

International Journal of Environmental Research and Public Health
|August 28, 2025
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Summary

Public opinion favors equitable healthcare rationing for all gender identities. Egalitarian approaches are preferred, ensuring fairness and public interest in healthcare policy decisions.

Keywords:
affirmationegalitarianismequitypersonal contributionpublic healthcarepublic interestrationalityrationingself-interestsocial contributionuniversalism

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Area of Science:

  • Social Sciences
  • Public Health Policy
  • Healthcare Ethics

Background:

  • Public opinion on healthcare rationing is vital for policy-making, especially concerning sexual orientation, gender identity, and gender expression (SOGIE).
  • Rationality theory suggests equitable rationing balances public interest with equity orientations (equality, need, contribution).

Purpose of the Study:

  • To investigate public preferences for public healthcare rationing strategies concerning SOGIE.
  • To analyze the influence of equity orientations and public interest on these preferences.

Main Methods:

  • A web survey was conducted with 744 participants in China.
  • Participants indicated preferences for healthcare rationing, self-interest, public interest, and various equity orientations.

Main Results:

  • Healthcare rationing equal across all SOGIE identities was predominantly preferred, aligning with rational equity principles.
  • Rationing that did not consider SOGIE was less preferred, and unequal rationing based on gender identity was not favored.
  • Public interest and egalitarian equity orientations significantly predicted preferences for equitable rationing.

Conclusions:

  • Affirmative and egalitarian healthcare rationing is the most rationally equitable approach.
  • Policies should prioritize equal access to public healthcare regardless of SOGIE to align with public preferences and rational equity.