https://orcid.org/0000-0001-9311-6747
Abstract
Purpose
The aim of this study was to quantify the relative importance of the preference heterogeneity of Chinese older adults with chronic disease for primary healthcare service (PHCS) in the hypothetical minor chronic disease scenario.
Patients and Methods
A discrete choice experiment (DCE) was administered to the patients aged 60 and above with at least one chronic disease in China. Five DCE attributes were considered, including types of service, treatment options, out-of-pocket (OOP) cost per visit, distance to practice, and the seniority of medical practitioners. DCE data were analysed taking into account of potential preference heterogeneity using both a mixed logit model (MLM) and a latent class logit model (LCLM).
Results
A total of 432 respondents consented to complete the questionnaires and 372 valid respondents were included in analysis. All attributes were significantly influencing respondents’ PHCS choice except for the types of service. Significant preference heterogeneity was observed among respondents. Based on the preferred LCLM estimates, four latent classes were identified. The first class (28.8%) valued modern medicine service the most, the second class (17.8%) was dominated by distance to practice, the third class (29%) preferred all the attributes except the types of services and valued TCM service most, the fourth class (24.4%) paid more attention to the types of service. Education, gender, age, income, regions of residence, and status of the chronic condition were found to be associated with latent class memberships.
Conclusion
A better understanding of the relative importance of PHCS characteristics is a crucial step for the future policy implementations. The significant preference heterogeneity identified in this study highlights that effective policy interventions should be tailored to different patients’ characteristics.
Abbreviations
AIC, Akaike information criterion; BIC, Bayesian information criterion; CI, confidence interval; CHC, community healthcare center; CNY, Chinese Yuan; DCE, discrete choice experiment; LCLM, latent class logic model; Mins, minute; MM, Modern Medicine; MWTP, marginal willingness to pay; OOP, Out-of-pocket; OR, odds ratio; PHC, primary healthcare; PHCS, primary healthcare service; RI, relative importance; SD, standard deviation; SE, standard error; SES, socioeconomic status; TCM, traditional Chinese Medicine; USD, United States dollar.
Details of Ethics Approval
The study protocol and verbal informed consent were acceptable and approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (IORG No: IORG0003571). All participants were informed of the purpose, method and publication of the study, that participation was anonymous and voluntary, and that they could withdraw at any time.
Acknowledgments
We are grateful to the Health Commissions of Shanghai Municipal, Taizhou Municipal, Xuchang Municipal, Wuhan Municipal, Chengdu Municipal, Guizhou Municipal for assistance at the stage of data collection. We would like to thank all the participants for their involvement. This study was funded by the National Natural Science Foundation of China (Grant number 71673095). Gang Chen, Ph.D., contributed to the polishing and advised on statistical analysis.
Author Contributions
All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. Gang Chen, Ph.D., who contributed to the polishing and advised on statistical analysis.
Disclosure
The authors report no conflicts of interest in this work.