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Lin W, Dong X, Hennessy J, Zhao J, Ma X. Exploring the Preferences of Parents of Children with Myopia in Rural China for Eye Care Services Under Privatization Policy: Evidence from a Discrete Choice Experiment. THE PATIENT 2024; 17:133-145. [PMID: 38072882 DOI: 10.1007/s40271-023-00660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVES This study aims to measure the preferences and valuations of parents of students with myopia parents for eye care service attributes in rural China, and to quantify the potential welfare impacts of privatization policy on children's eye care services. METHODS A discrete choice experiment was designed and implemented among a sample of parents of children with myopia in rural China. We randomly selected 350 participants from the list of subjects obtained from local town schools and family doctors using a random number table method. The participants were asked to choose between two hypothetical scenarios defined by five attributes: provider type, distance, price, lenses type, and refractionists' professional competencies. We estimate conditional logit and mixed logit models to approximate individual preferences for these attributes and estimate the welfare effects by calculating willingness to pay. RESULTS Respondents (n = 336) showed a significant preference for public providers of refractive error services, myopia control lenses, and professional refractionists (P < 0.01 for each). Consumer welfare losses due to a prohibition of the public provision of refractive error services could be compensated by improving the quality of products and services delivered by private providers. Lastly, both parent and child demographics and previous experience of eye care service consumption are important predictors of willingness to pay for refractive error services. CONCLUSIONS The privatization policy on children's eye care services would not cater to the preferences of rural consumers, inevitably leading to welfare losses. However, reduced consumer welfare could be compensated by improving the quality of products and service delivery from private providers. These results could help inform strategies to improve and reduce inequities in access to high-quality eye care services in rural China.
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Affiliation(s)
- Wen Lin
- College of Economics and Management, Nanjing Agricultural University, Nanjing, China
| | - Xiaodong Dong
- School of Public Health, Peking University, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Jack Hennessy
- The Fred Hollows Foundation, Melbourne, VIC, Australia
- Monash Business School, Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
| | - Junling Zhao
- School of Public Health, Peking University, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
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Lv Y, Qin J, Feng X, Li S, Tang C, Wang H. Preferences of patients with diabetes mellitus for primary healthcare institutions: a discrete choice experiment in China. BMJ Open 2023; 13:e072495. [PMID: 37369417 PMCID: PMC10410837 DOI: 10.1136/bmjopen-2023-072495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES To quantify the preference of patients with diabetes mellitus (DM) for primary healthcare (PHC) institutions in China to redirect the patient flow and improve health outcomes. DESIGN Cross-sectional study. Discrete choice experiment (DCE) surveys asked patients with DM to choose between hypothetical institutions that differed in the medical service capacity, out-of-pocket (OOP) medical costs per month, travel time, the attitude of medical staff and the availability of diabetes drugs. SETTING Shandong province, China. PARTICIPANTS The participants were 887 patients with DM from 36 urban communities and 36 rural villages in Shandong province. One participant did not provide any DCE answers and a further 57 patients failed the internal consistency test. 829 fully completed surveys were included in the final data analysis. MAIN OUTCOMES AND MEASURES A mixed logit model was used to calculate the willingness to pay and predict choice probabilities for PHC institution attributes. Preference heterogeneity was also investigated. RESULTS All five attributes were associated with the preferences of patients with DM. The OOP medical costs and the medical service capacity were the most influential attributes. Improvements simultaneously in the attitude of medical staff, drug availability and travel time increased the likelihood of a patient's PHC institution choice. Preferences differed by region, annual household income and duration of diabetes. CONCLUSIONS Our patient preference data may help policymakers improve health services and increase acceptance of choosing PHC institutions. The OOP medical costs and medical service capacity should be regarded as a priority in decision-making.
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Affiliation(s)
- Yuyu Lv
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Jingzhu Qin
- Hospital Office, Qingdao Municipal Hospital, Qingdao, China
| | - Xia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - ShunPing Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Chengxiang Tang
- Macquarie University Centre for the Health Economy, Macquarie Business 14 School & Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Haipeng Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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Genie MG, Nicoló A, Pasini G. The role of heterogeneity of patients' preferences in kidney transplantation. JOURNAL OF HEALTH ECONOMICS 2020; 72:102331. [PMID: 32480101 DOI: 10.1016/j.jhealeco.2020.102331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
We elicit time and risk preferences for kidney transplantation from the entire population of patients of the largest Italian transplant centre using a discrete choice experiment (DCE). We measure patients' willingness-to-wait (WTW) for receiving a kidney with one-year longer expected graft survival, or a low risk of complication. Using a mixed logit in WTW-space model, we find heterogeneity in patients' preferences. Our model allows WTW to vary with patients' age and duration of dialysis. The results suggest that WTW correlates with age and duration of dialysis, and that accounting for patients' preferences in the design of kidney allocation protocols could increase their welfare. The implication for transplant practice is that eliciting patients' preferences could help in the allocation of "non-ideal" kidneys.
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Affiliation(s)
- Mesfin G Genie
- Dipartimento di Economia, Università Ca' Foscari di Venezia, Cannaregio 873, Fondamenta San Giobbe, 30121 Venezia, Italy; Health Economics Research Unit, University of Aberdeen, Aberdeen AB25 2QN, UK
| | - Antonio Nicoló
- Dipartimento di Scienze Economiche "Marco Fanno", Università degli Studi di Padova, Via del Santo 33, 35123 Padova, Italy; School of Social Sciences, The University of Manchester, Manchester M13 9PL, UK
| | - Giacomo Pasini
- Dipartimento di Economia, Università Ca' Foscari di Venezia, Cannaregio 873, Fondamenta San Giobbe, 30121 Venezia, Italy; NETSPAR, Network for Studies on Pensions, Ageing and Retirement, Tilburg, The Netherlands
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Zhu J, Li J, Zhang Z, Li H, Cai L. Exploring determinants of health provider choice and heterogeneity in preference among outpatients in Beijing: a labelled discrete choice experiment. BMJ Open 2019; 9:e023363. [PMID: 30948563 PMCID: PMC6500246 DOI: 10.1136/bmjopen-2018-023363] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE For a long time in China, public hospitals have been the most prominent provider of healthcare. However, recent policy reforms mean the private sector is experiencing rapid development. Thus, the purpose of this study is to detect whether the policies published by the government aimed to improve the quality of healthcare services were catering to patient's preferences. PARTICIPANTS AND METHODS Our work uses dental care as an example of services provided in outpatient setting and takes advantage of a labelled discrete choice experiment with a random sample of respondents from Beijing. Participants were asked to make a choice between four healthcare providers with different attributes. Mixed logit and latent class models were used for the analysis. RESULT Care provided by high-level private hospitals and community hospitals were valued RMB154 and 216 less, respectively, than care provided by class A tertiary hospitals, while the most disliked provider was private clinics. This was the most valued attribute of dental care. Respondents also value: lower waiting times, the option to choose their doctor, lower treatment costs, shorter travel times and a clean waiting room. However, when the level of provider was analysed, the prevailing notion that patients in China were always likely to choose public services than private services no longer holds. Four classes of patients with distinct preferences for dental care provider choice were identified, which can partly be explained by age, income, experience and Hukou status-a household registration permit. DISCUSSION The study to some extent challenged the overwhelming predominance of public healthcare providers in China. The preference heterogeneity we found was relatively large. Our findings are significant for providers in developing more specific services for patients and for policymakers in weighing the pros and cons of future initiatives in medical reform.
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Affiliation(s)
- Jingrong Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Zengbo Zhang
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Hao Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Lingfei Cai
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 387] [Impact Index Per Article: 77.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Marti J, Buckell J, Maclean JC, Sindelar J. To "vape" or smoke? Experimental evidence on adult smokers. ECONOMIC INQUIRY 2019; 57:705-725. [PMID: 30559550 PMCID: PMC6294299 DOI: 10.1111/ecin.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/10/2018] [Indexed: 05/19/2023]
Abstract
A growing share of the United States population uses e-cigarettes but the optimal regulation of these controversial products remains an open question. We conduct a discrete choice experiment to investigate how adult tobacco cigarette smokers' demand for e-cigarettes and tobacco cigarettes varies by four attributes: (i) whether e-cigarettes are considered healthier than tobacco cigarettes, (ii) the effectiveness of e-cigarettes as a cessation device, (iii) bans on use in public places, and (iv) price. We find that adult smokers' demand for e-cigarettes is motivated more by health concerns than by the desire to avoid smoking bans or higher prices.
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Affiliation(s)
- Joachim Marti
- Lecturer, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland;
| | - John Buckell
- Post-doctoral Associate, School of Public Health, Yale University,
| | | | - Jody Sindelar
- Professor, School of Public Health, Yale University, NBER, & IZA,
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Women's Preferences for Birthing Hospital in Denmark: A Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:613-624. [PMID: 29766464 DOI: 10.1007/s40271-018-0313-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Free choice of hospital has been introduced in many healthcare systems to accommodate patient preferences and incentivize hospitals to compete; however, little is known about what patients actually prefer. OBJECTIVES This study assessed women's preferences for birthing hospital in Denmark by quantifying the utility and trade-offs of hospital attributes. METHODS We conducted a discrete-choice experiment survey with 12 hypothetical scenarios in which women had to choose between three hospitals characterized by five attributes: continuity of midwifery care, availability of a neonatal intensive care unit (NICU), hospital services offered, level of specialization to handle rare events, and travel time. A random parameter logit model was used to estimate the utility and marginal willingness to travel (WTT) for improvements in other hospital attributes. RESULTS A total of 517 women completed the survey. Significant preferences were expressed for all attributes (p < 0.01), with the availability of a NICU being the most important driver of women's preferences; women were willing to travel 30 more minutes (95% confidence interval 28-32) to reach a hospital with a highly specialized NICU. The subgroup analyses revealed differences in WTT, with substantial heterogeneity due to prior experience with giving birth and regarding risk attitude and health literacy. CONCLUSION A high specialization level was the most influential factor for women without previous birth experience and for risk-averse individuals but not for women with a high health literacy score. Hence, more information about the woman's risk profile and services required could play a role in affecting hospital choice.
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Schuldt J, Doktor A, Lichters M, Vogt B, Robra BP. Insurees' preferences in hospital choice-A population-based study. Health Policy 2017; 121:1040-1046. [PMID: 28823608 DOI: 10.1016/j.healthpol.2017.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/28/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
Abstract
In Germany, the patient himself makes the choice for or against a health service provider. Hospital comparison websites offer him possibilities to inform himself before choosing. However, it remains unclear, how health care consumers use those websites, and there is little information about how preferences in hospital choice differ interpersonally. We conducted a Discrete-Choice-Experiment (DCE) on hospital choice with 1500 randomly selected participants (age 40-70) in three different German cities selecting four attributes for hospital vignettes. The analysis of the study draws on multilevel mixed effects logit regression analyses with the dependent variables: "chance to select a hospital" and "choice confidence". Subsequently, we performed a Latent-Class-Analysis to uncover consumer segments with distinct preferences. 590 of the questionnaires were evaluable. All four attributes of the hospital vignettes have a significant impact on hospital choice. The attribute "complication rate" exerts the highest impact on consumers' decisions and reported choice confidence. Latent-Class-Analysis results in one dominant consumer segment that considered the complication rate the most important decision criterion. Using DCE, we were able to show that the complication rate is an important trusted criterion in hospital choice to a large group of consumers. Our study supports current governmental efforts in Germany to concentrate the provision of specialized health care services. We suggest further national and cross-national research on the topic.
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Affiliation(s)
- Johannes Schuldt
- Institute for Social Medicine and Health Economics, Otto-von-Guericke-University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Anna Doktor
- Institute for Social Medicine and Health Economics, Otto-von-Guericke-University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Marcel Lichters
- Department of Consumer Behavior, Faculty of Economics and Management, Otto-von-Guericke-University of Magdeburg, P.O. Box 4120, 39016 Magdeburg, Germany.
| | - Bodo Vogt
- Institute for Social Medicine and Health Economics, Otto-von-Guericke-University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany; Department of Empirical Economics, Faculty of Economics and Management, Otto-von-Guericke-University of Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany.
| | - Bernt-Peter Robra
- Institute for Social Medicine and Health Economics, Otto-von-Guericke-University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
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Gutacker N, Siciliani L, Moscelli G, Gravelle H. Choice of hospital: Which type of quality matters? JOURNAL OF HEALTH ECONOMICS 2016; 50:230-246. [PMID: 27590088 PMCID: PMC5138156 DOI: 10.1016/j.jhealeco.2016.08.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 06/27/2016] [Accepted: 08/16/2016] [Indexed: 05/25/2023]
Abstract
The implications of hospital quality competition depend on what type of quality affects choice of hospital. Previous studies of quality and choice of hospitals have used crude measures of quality such as mortality and readmission rates rather than measures of the health gain from specific treatments. We estimate multinomial logit models of hospital choice by patients undergoing hip replacement surgery in the English NHS to test whether hospital demand responds to quality as measured by detailed patient reports of health before and after hip replacement. We find that a one standard deviation increase in average health gain increases demand by up to 10%. The more traditional measures of hospital quality are less important in determining hospital choice.
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Affiliation(s)
- Nils Gutacker
- Centre for Health Economics, University of York, York, United Kingdom.
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, United Kingdom
| | - Giuseppe Moscelli
- Centre for Health Economics, University of York, York, United Kingdom
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, United Kingdom
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