Preferences heterogeneity of health care utilization of community residents in China: a stated preference discrete choice experiment

Abstract

Background To tackle the issue with the low usage of primary healthcare service in China, it is essential to align resource distribution with the preferences of the community residents. There are few academic researches for describing residents’ perceived characteristics of healthcare services in China. This study aims to investigate the preferences of healthcare services utilization in community residents and explore the heterogeneity. The findings will be useful for the policy makers to take targeted measures to tailor the provision of healthcare services. Methods The face-to-face interviews and surveys were conducted to elicit four key attributes (care provider; mode of services; cost; travel time) of the preference from community residents for healthcare utilization. A rational test was presented first to confirm the consistency, and then 16 pairs of choice tasks with 12 sociodemographic items were given to the respondents. Two hypothetical options for each set, without an opt-out option, were presented in each choice task. The latent class analysis (LCA) was used to analyse the data. Results Two thousand one hundred sixty respondents from 36 communities in 6 cities were recruited for our study. 2019 (93.47%) respondents completed valid discrete choice experiment (DCE) questionnaires. The LCA results suggested that four groups of similar preferences were identified. The first group (27.29%) labelled as “Comprehensive consideration” had an even preference of all four attributes. The second group (37.79%) labelled as “Price-driven” preferred low-price healthcare services. The third group labelled as “Near distance” showed a clear preference for seeking healthcare services nearby. The fourth group (34.18%) labelled as “Quality seeker” preferred the healthcare service provided by experts. Willingness to pay (WTP) results showed that people were willing to accept CNY202.12($29.37) for Traditional Chinese Medicine (TCM) services and willing to pay CNY604.31($87.81) for the service provided by experts. Conclusions Our study qualitatively measures the distinct preferences for healthcare utilization in community residents in China. The results suggest that the care provider, mode of services, travel time and cost should be considered in priority setting decisions. The study, however, reveals substantial disagreement in opinion of TCM between different population subgroups.

The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018

“…However, PHC utilization is comparatively lower than that of non-PHC institutions in China, and the doctors’ outpatient volume in higher-tier hospitals is six to ten times more than those in PHC institutions [ 7 ]. Patients’ preference for different types of medical institutions determined the PHC utilization in China [ 8 ]. Studies on the PHC preference can help optimize the PHC service delivery system, but it was far from sufficient.…”

“…Previous studies about PHC preference mainly concentrated on the determinants of choosing PHC services and limited in research data. For example, characteristics of care provider, service mode, cost or cost-sharing policy, individuals' characteristics, and their experiences with PHC were the key factors impacting the preference for PHC [2,[8][9][10][11]. The provision and utilization of PHC in China varied from region to region due to large differences in socioeconomic factors and health policies [12,13].…”

Identification and Prioritization of Attributes for a Discrete Choice Experiment Using the Nominal Group Technique: Patients’ Choice of Public Health Facilities in Cape Town, South Africa

“…15 These factors were also found in studies that reviewed the access, availability, and affordability of healthcare in South Africa [15][16][17][18][19] and in other countries including Albania, China, Iran, Jordan, Nigeria, Pakistan, Spain, Tanzania, and Uganda. [20][21][22][23][24][25][26][27][28][29][30][31][32][33] A list of possible attributes to be presented to the participants was compiled, with the concurrence of the Northern Tygerberg substructure team, resulting in the finalization of the pregroup discussion list. Table 1 summarizes articles from which the attributes were retrieved, mainly from South African-related articles, thus providing a glimpse into patient preferences in the country of study.…”

“…Some studies did not quite mirror the attributes extracted from our group discussions, possibly caused by different objectives and study methodologies. Studies in South Africa, 9 China, 21,25,26,29,30 India, 20 Iran, 27 Jordan, 33 Spain, 28 and Albania 44 included age, education, employment, travel time, transport costs, chronic illness, medication availability, illness gravity, accessibility, type of service provided, previous experience, care providers, and facilities infrastructure.…”

Enhancing Public Participation in Public Health Offerings: Patient Preferences for Facilities in the Western Cape Province Using a Discrete Choice Experiment

“…Even though there is a large body of work on stated preferences, only a few studies have been conducted regarding patients’ choice of facility, specifically within public health care. A systematic review of DCEs used to elicit patient preferences for primary healthcare showed that most studies were American or European, and focused on general practitioner (GP) consultations, [ 26 ] while Chinese studies appeared to focus primarily on the public health preferences of rural populations [ 27 , 28 , 29 , 30 ]. Only one South African DCE of public health facility preferences was identified [ 5 ].…”