COVID-19, Health Equity
Conditions
Keywords
Allocation of Healthcare Resources
Brief summary
In a randomized survey experiment, investigators will assess public support or opposition towards one of three potential government plans for allocating at-home coronavirus disease 2019 (COVID-19) tests to United States residents: 1) first come, first served; 2) a random draw; or 3) a random draw with 20% of tests reserved for disadvantaged areas. Investigators will also examine public attitudes surrounding other logistical and equity-related aspects of these allocation plans.
Detailed description
Complementing other efforts to increase access to COVID-19 testing in the United States, the federal government recently announced the purchase of 500,000,000 at home COVID-19 to be distributed for free to Americans that want them. A central logistical element in matching supply with demand will be a website, on which people will register their interest in getting tests delivered to their home address. However, it is still unclear how supply will be matched with demand. Three main candidate options are first come, first served (FCFS), in which people are sent tests in the order in which they make requests; a random draw, such as a lottery; or a combination of a random draw with a guaranteed reserved amount for more disadvantaged populations. FCFS is a widely known and practiced rationing principle, but it has shown to exacerbate inequities in, for example, the allocation of vaccine appointments. Random draws can mitigate this impact, but, in the present context, might be insufficiently sensitive to the fact that not everyone has internet access, and that the need for testing is greater among more disadvantaged communities. Combining a lottery with a disadvantage reserve system using measures such as the CDC's Social Vulnerability Index is a practical way of promoting equity, and it was already used by the majority of US states in allocating vaccines. The main objective of this study is to assess public support for each of these three allocation plans and describe differences by demographic characteristics. Investigators will also assess public attitudes toward specific details of these allocation plans. The study, which is expected to take approximately 5 minutes to complete, will be administered as part of an omnibus online survey.
Interventions
BEHAVIORALFirst Come, First Served
Respondents will view the following description of the plan: Tests will be sent out in the order they are requested. People who request tests the quickest will get them first, no matter where they live. People who request tests later may not get any. This strategy is also known as 'First Come, First Served.'
BEHAVIORALRandom
Respondents will view the following description of the plan: People who request tests will be entered into a random drawing, like a sweepstakes or lottery. Everyone who is in the drawing has the same chance of getting tests, no matter where they live, but some people may not get any tests.
BEHAVIORALDisadvantaged Priority & Random
Respondents will view the following description of the plan: Because COVID-19 has hit people living in disadvantaged areas of the country harder, a proportion of tests will be sent exclusively to people in these zip codes. Planners will allocate 80% of the tests using a random drawing, like a sweepstakes or lottery. Everyone who is in the drawing has the same chance of getting tests, no matter where they live. The remaining 20% are set aside exclusively for the most disadvantaged areas, again allocated with a random drawing. Some people may not get any tests. But people living in disadvantaged areas are more likely to get them.
Sponsors
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Aged 18 years old or older, United States resident
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Support for allocation plan | 5 minutes | Self-reported degree of support for the plan, measured on a 5-point Likert scale (strongly oppose to strongly support) that will be collapsed into 3 response categories (oppose, neutral, and support) for analysis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Household-level test allocation preference | 5 minutes | Preferred way of sending tests to households, measured as a binary choice between a fixed or variable (based on household size) number of tests per household. |
| Tests allocated to disadvantaged areas | 5 minutes | Self-reported percentage of tests wanted to be sent to disadvantaged areas, measured as a continuous variable on a slider from 0% to 100% with increments of 0.1%. This outcome will only be measured for respondents in the Disadvantaged Priority & Random condition. |
Countries
United States
Outcome results
None listed