Preferences for healthcare services among hypertension patients in China: a discrete choice experiment

Abstract

ObjectivesOur study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients.DesignWe identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients’ preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients.SettingThe DCE was conducted in Jiangsu province and Shanghai municipality in China.ParticipantsPatients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited.ResultsPatients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician–patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients’ choice (β=−0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial.ConclusionsOur findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients’ preferences.

Factors Associated with Outpatient Satisfaction in Provincial Tertiary Hospitals in Nanchang, China: A Structural Equation Modeling Approach

“…It is consistent with that of Zhou and colleagues [ 21 ]. First, the primary purpose of seeking medical service for most outpatients in China is to be cured [ 4 , 14 ]. However, most of them lack medical expertise.…”

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“…Although methods such as improving appointment systems have been used to reduce the waiting time, outpatients still face long waits due to the imbalance between supply and demand for medical services [ 11 ]. The long waits may lead to inadequate treatment and poor doctor–patient communication, provoke the occurrence of doctor–patient conflicts, and result in dissatisfaction [ 14 ]. Related research has confirmed the prevalence of this phenomenon in developing countries [ 15 ].…”

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Healthcare preferences of the general Chinese population in the hierarchical medical system: A discrete choice experiment

“…The study of Wan et al (16) found that people's preferences toward primary healthcare closely correlated with their socioeconomic status and health status. Yu et al (17) investigated healthcare services preference among hypertension patients in China found that hypertension patients prefer treatment effect and travel time to healthcare facilities the most. Therefore, there is an evident research gap exists between the current study and previous studies in China, i.e., (1) The existing literature mainly focuses on a specific disease, without concerning different situations, e.g., focusing on the specific disease such as hypertension, without concerning infectious diseases, especially during the COVID-19 epidemic outbreak (2) Most of the existing studies only applied a single model, e.g., only using univariate analysis or logistic regressions; and (3) The key factor of "medical insurance reimbursement ratio" has been .…”