論文

Introduction Context-specific cost-effectiveness thresholds (CETs) informed by societal willingness to pay (WTP) are crucial for healthcare resource allocation in low- and middle-income countries. This study investigated WTP for health per quality-adjusted life year (QALY) in Bhutan. Methods A WTP survey was conducted alongside the 2023 National Health Survey in Bhutan, sampling 1869 households. Using contingent valuation, respondents assigned monetary values to three hypothetical scenarios: 1 year of cancer symptom-free life, 1 year of perfect health and 5 years of perfect health. We used generalised linear regression to estimate WTP, controlling for demographic, socioeconomic and health-related factors, as well as elicitation methods. Multilevel analyses examined WTP variations within and between districts. Results WTP estimates were 76 836 Bhutanese ngultrum (BTN) (0.26 times gross domestic product (GDP) per capita; 95% CI: 71 397 to 82 275) for a year without cancer symptoms, 104 381 BTN (0.35 times GDP per capita; 95% CI: 96 405 to 112 357) for 1 QALY and 235 237 BTN (0.78 times GDP per capita; 95% CI: 218 674 to 251 800) for 5 QALYs. WTP variations were driven by within-district individual characteristics, particularly income and education, rather than between-district differences. Conclusion Minimal between-district WTP variations support a national-level CET for Bhutan. However, WTP-based CETs would be biased upward by wealthier and more educated groups. This bias could justify expensive technologies that strain public resources in Bhutan's government-funded healthcare system.

This study uses data from an ongoing, open-cohort, longitudinal China Health and Nutrition Survey to examine how the environmental regulation aimed at abating sulfur dioxide (SO2) alters income distribution. We find that this regulation induces a 14%–27% decrease in income inequality, depending on the measurement method. An improvement in income inequality is achieved by lowering the wages of high-income groups while keeping the wages of low-income groups (especially blue-collar workers) unchanged. This change in the labor market can be attributed to a policy that primarily targets emissions from power plants while leaving the manufacturing sector unaffected. As a result, the manufacturing sector continues to create jobs and absorb the blue-collar workers dismissed from other sectors, mitigating the widening income gap. Our study sheds new light on the role of environmental policy in reshap-ing the labor market and its implications for income distribution.