Preferences for Primary Healthcare Services Among Older Adults with Chronic Disease: A Discrete Choice Experiment

Figures & data

Table 1 DCE Attributes and Attribute Levels

Attribute	Explanation	Levels
Types of service	Different types of services chosen by patients when they are registered. Its levels come from the literature.^Citation30	·General service ·Specialized service
Treatment options	Different treatment options, which inspired by the current primary healthcare policies^Citation9 and specialists’ views.	·Traditional Chinese Medicine(TCM) ·Modern Medicine(MM) ·Integrated TCM and MM
OOP cost per visit (CNY)	The amount patients pay per visit that will not be reimbursed by medical insurance. Its levels were constructed based on the statistical data^Citation31 and experts’ focus group discussions.	·100 CNY (14 USD) ·200 CNY (28 USD) ·300 CNY (42 USD)
Distance to practice	Distance to practice was a proxy by using the time required to go to the medical institution from home (one-way travel).^Citation32 Its levels were proposed based on the interviews with the representative respondents.	·<30 mins ·≥30 mins
Seniority of medical practitioner	The medical practitioner was classified by the medical practitioner’s experience and skill.^Citation23,Citation33 Its levels were based on the current types of outpatient registration services in China.^Citation34,Citation35	·Senior medical practitioner ·Junior medical practitioner

Note: The US dollar to Chinese Yuan Renminbi exchange rate in 2018 was 1 USD=6.62 CNY.³⁶

Table 2 An Example of a Choice Set from the Discrete Choice Experiment

Imagine You Have a Mild Chronic Disease, the Perceived Minor Chronic Disease Causes Occasional Discomfort and Does Not Seriously Affect Daily Life, Even without Medical Attention. Which of the Following Two Primary Healthcare Services Do You Prefer?
Attributes	Service A	Service B
Types of service	Specialized service	General service
Treatment options	Modern medicine service	Traditional Chinese medicine service
Seniority of medical practitioner	Senior medical practitioner	Junior medical practitioner
Distance to practice	≥30 mins	<30 mins
Out-of-pocket cost for a visit	100 CNY	200 CNY
Please tick one box only	□	□

Table 3 Characteristics of Participants

Characteristics	n (%)
Gender: Female	240 (64.5)
Age, Mean±SD	71.2±7.1
Household members, Mean±SD	3.3±0.03
Monthly household income per capita (CNY), Mean±SD	3978.6±2842.5
Marital status, married	317 (85.2)
Education
Elementary school or less	165 (44.3)
High school or equivalent	160 (43.0)
Undergraduate or above	47 (12.6)
Region of residence
Eastern region	112 (30.1)
Central region	140 (37.6)
Western region	120 (32.2)
Has medical insurance (Yes)	361 (97.0)
Status of the chronic condition
One chronic condition	242 (65.1)
Multimorbid conditions^a	130 (34.9)
Self-rated economic burden of chronic disease
Severe	4 (1.1)
High	221 (59.4)
Affordable	147 (39.5)

Note: ^aIndividuals have two or more chronic conditions which were referred to as multimorbid conditions.

Abbreviation: SD, standard deviation.

Figure 1 Results mixed logit model.

Notes: (i) *Coefficients are significant at p<0.05; (ii) The vertical bar surrounding each mean preference weight denotes the 95% confidence interval for the point estimate; (iii) “OOP cost per visit” coefficient fixed, it indicates the size of the utility for each additional CNY.

Abbreviation: RI, relative importance.

Figure 2 Latent Class model estimates: Likelihood of preferring PHCS scenario for each latent class (OR with 95% CI).

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