Preferences for Attributes of Initial COVID-19 Diagnosis in the United States and China During the Pandemic: Discrete Choice Experiment With Propensity Score Matching

Abstract

Background China and the United States play critical leading roles in the global effort to contain the COVID-19 virus. Therefore, their population’s preferences for initial diagnosis were compared to provide policy and clinical insights. Objective We aim to quantify and compare the public’s preferences for medical management of fever and the attributes of initial diagnosis in the case of presenting symptoms during the COVID-19 pandemic in China and the United States. Methods We conducted a cross-sectional study from January to March 2021 in China and the United States using an online discrete choice experiment (DCE) questionnaire distributed through Amazon Mechanical Turk (MTurk; in the United States) and recruited volunteers (in China). Propensity score matching (PSM) was used to match the 2 groups of respondents from China and the United States to minimize confounding effects. In addition, the respondents’ preferences for different diagnosis options were evaluated using a mixed logit model (MXL) and latent class models (LCMs). Moreover, demographic data were collected and compared using the chi-square test, Fisher test, and Mann-Whitney U test. Results A total of 9112 respondents (5411, 59.4%, from China and 3701, 40.6%, from the United States) who completed our survey were included in our analysis. After PSM, 1240 (22.9%) respondents from China and 1240 (33.5%) from the United States were matched for sex, age, educational level, occupation, and annual salary levels. The segmented sizes of 3 classes of respondents from China were 870 (70.2%), 270 (21.8%), and 100 (8.0%), respectively. Meanwhile, the US respondents’ segmented sizes were 269 (21.7%), 139 (11.2%), and 832 (67.1%), respectively. Respondents from China attached the greatest importance to the type of medical institution (weighted importance=40.0%), while those from the United States valued the waiting time (weighted importance=31.5%) the most. Respondents from China preferred the emergency department (coefficient=0.973, reference level: online consultation) and fever clinic (a special clinic for the treatment of fever patients for the prevention and control of acute infectious diseases in China; coefficient=0.974, reference level: online consultation), while those from the United States preferred private clinics (general practices; coefficient=0.543, reference level: online consultation). Additionally, shorter waiting times, COVID-19 nucleic acid testing arrangements, higher reimbursement rates, and lower costs were always preferred. Conclusions Improvements in the availability of COVID-19 testing and medical professional skills and increased designated health care facilities may help boost potential health care seeking during COVID-19 and prevent unrecognized community spreading of SARS-CoV-2 in China and the United States. Moreover, to better prevent future waves of pandemics, identify undiagnosed patients, and encourage those undiagnosed to seek health care services to curb the pandemic, the hierarchical diagnosis and treatment system needs improvement in China, and the United States should focus on reducing diagnosis costs and raising the reimbursement rate of medical insurance.

Towards an Integrated Online–Offline Healthcare System: Exploring Chinese Patients’ Preferences for Outpatient Follow-Up Visits Using a Discrete Choice Experiment

“…These assumptions can be restrictive in describing choice behaviour, so researchers continue to develop more realistic choice models. In recent years, the MXL model has become one of the more flexible discrete choice models and is now widely used [19,21,23]. MXL is a generalization of MNL that relaxes the IIA assumption, accommodates the panel nature of DCE data by allowing for correlation of the subjects who have made repeated choices, and captures the heterogeneity of preferences across individuals by allowing model coefficients to vary across respondents [42].…”

“…In particular, as an innovative application of information technology in the medical field, telehealth has not been used adequately and effectively, and it is therefore valuable to investigate the issue of patient preferences for telehealth in order to provide appropriate services in response to patient preferences. As discrete choice experiments have a well-established theoretical basis and are widely used [18][19][20][21][22][23], it is feasible to use this approach in this study. Lancaster's new approach to consumer theory [47] proposes that the utility of a good is derived from the characteristic attributes of the good, rather than from the good itself.…”

“…The discrete choice experiment (DCE) has become a commonly used, stated preference technique in health economics and health policy analysis because it allows not only to quantify the extent to which respondents trade off different telehealth attributes, but also to estimate the willingness to pay (WTP) for a change in the level of the preferred attribute and to predict the probability of choosing a particular telehealth service alternative [15][16][17]. Studies that have used DCE to measure respondents' preferences for telehealth services versus traditional healthcare have typically found that cost, speed of access to care, including long-term waiting time (waiting for an available appointment) and short-term waiting time (waiting on the day of the appointment), quality of consultation, and continuity of care are important factors influencing the choice of healthcare services [13,[18][19][20][21][22][23]. The majority of these studies found that patients preferred traditional healthcare, lower cost, shorter waiting time, and more familiar doctors.…”

“…Specifically, preferences for telehealth services versus traditional healthcare have been investigated in different healthcare scenarios, such as web-based exercise telerehabilitation [13], cardiac telemedicine (new diagnosis for heart problems) [18], primary care consultations (consultation with a family doctor, consultation for antibiotic treatment, etc.) [19][20][21][22], and initial COVID-19 diagnosis [23]. In the area of telerehabilitation, research has shown that chronic pain patients prefer face-to-face consultations with physicians to consultations that are fully or partly delivered via remote video communication [13].…”

“…Another study compared the preferences for initial fever diagnostic attributes of the Chinese and American public during the COVID-19 pandemic. Chinese respondents expressed a preference for visiting a fever clinic over online consultations, while American respondents preferred private clinics [23].…”