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Jiang F, Feng Y, Zong W, Xue J, Chen W, Qizhi L, Zhang J, Xu A. Urban-rural differences in preferences for traditional Chinese medicine services among chronic disease patients: a discrete choice experiment. BMC Complement Med Ther 2024; 24:369. [PMID: 39402534 PMCID: PMC11475649 DOI: 10.1186/s12906-024-04659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 09/23/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND With the increasing prevalence of chronic diseases, the demand for medical services from chronic disease patients has become diversified and personalized. The advantages and role of traditional Chinese medicine in the prevention and treatment of chronic diseases gradually emerging. The preferences and willingness to pay for traditional Chinese medicine services (TCMS) among patients with chronic diseases, as well as any disparities between urban and rural patients, have not been examined in past studies. OBJECTIVE This study aimed to investigate the preferences of chronic disease patients for TCMS, explore the value/importance that patients place on different treatment attributes, and evaluate whether there are urban-rural differences in their preferences and willingness to pay for TCMS. METHODS A total of 317 patients from Jiangsu Province, China participated in a discrete choice experiment that elicited the preferences for TCMS. The choice questions were constructed by six attributes: out-of-pocket (OOP) cost, institution, medical provider, treatment method, treatment duration, treatment efficacy. Mixed logit models were used to estimate the stated preference and marginal willingness to pay for each attribute. RESULTS The choice preferences of chronic disease patients for TCMS in this study were influenced by the four attributes: institution, treatment method, and treatment efficacy, and OOP cost. Improvements in treatment efficacy were the most concerning, followed by being treated in traditional Chinese medicine (TCM) hospital. Patients were willing to pay more to get better treatment outcomes. Compared with primary care institutions, patients were willing to pay more for treatment in TCM hospitals. The preferences for economic attribute (OOP cost) varied between urban and rural areas, and rural patients tended to favor scenarios that imposed a lower economic burden on them. CONCLUSION The chronic disease patients' preferences for TCMS were determined mainly by treatment efficacy but also by institution, treatment method and OOP cost. The urban-rural difference in preference identified in this study highlights that effective policy interventions should consider the characteristics of patients' demand in different regions.
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Affiliation(s)
- Fan Jiang
- School of Health Economic and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuting Feng
- Center for Global Public Health, Chinese Center for Disease Control and Prevention , Beijing, China
| | - Wen Zong
- School of Health Economic and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianing Xue
- School of Health Economic and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wanning Chen
- School of Health Economic and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Liu Qizhi
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiao Zhang
- School of Health Economic and Management, Nanjing University of Chinese Medicine, Nanjing, China.
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Aijun Xu
- School of Health Economic and Management, Nanjing University of Chinese Medicine, Nanjing, China.
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China.
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Pathak A, Weber MA, Poulos C, Cohen SA, DeBruin V, Kandzari DE. Impact of expected blood pressure reduction on patient preferences for pharmaceutical and renal denervation treatment. J Hypertens 2024:00004872-990000000-00547. [PMID: 39324951 DOI: 10.1097/hjh.0000000000003872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
BACKGROUND Effective patient-centered care requires an adequate understanding of patient preferences for different therapeutic options. We modelled patient preference for blood pressure (BP) management by pharmaceutical or interventional treatments such as renal denervation in patients with different profiles of uncontrolled hypertension. METHODS Modeling was based on the findings from a previously conducted quantitative discrete choice experiment (DCE). The likelihood of selecting either an interventional treatment option or additional antihypertensive medication option was calculated for three patient profiles that represent the range of patients with hypertension commonly encountered in clinical practice: treatment-naive, patients with uncontrolled BP while on one to three antihypertensive medications, and patients with drug-resistant hypertension. Variables in the preference model were treatment attributes from the DCE study: expected reduction in office SBP with each treatment, duration of treatment effect, risk of reversible drug side effects from drugs, and risk of temporary pain and/or bruising or vascular injury from interventions. Values of the variables were derived from published clinical studies or expert opinion. RESULTS The model predicted that the likelihood of choosing renal denervation over initiating pharmacotherapy was 17.2% for previously untreated patients, 23.7% for patients with moderate hypertension currently on pharmacotherapy, and 41.8% for patients with drug-resistant hypertension. The dominant variable driving preference in these models was the expected BP reduction. Patient preferences for intervention are greater when drug nonadherence or increased SBP reduction at 3 vs. 1 year are included in the model. Baseline BP, drug side effects, or risks of the procedure had little influence on decisions. CONCLUSION Modeling using patient preference weights predicts that a substantial minority of patients favor an interventional treatment such as renal denervation over initiation or escalation of medications. Awareness of a patient's interest in device-based versus pharmaceutical strategies should inform the shared decision-making process for hypertension treatment.
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Affiliation(s)
- Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monaco
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Speckemeier C, Abels C, Höfer K, Niemann A, Wasem J, Walendzik A, Neusser S. Preferences for Living Arrangements in Dementia: A Discrete Choice Experiment. PHARMACOECONOMICS - OPEN 2024; 8:65-78. [PMID: 37995011 PMCID: PMC10781908 DOI: 10.1007/s41669-023-00452-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Dementia affects about 55 million people worldwide. Demographic change and shifting lifestyles challenge the organization of dementia care. A discrete choice experiment (DCE) was conducted to elicit preferences for living arrangements in dementia in urban and rural regions of Germany. METHODS Preliminary work included review of previous literature and focus groups. The DCE consists of seven attributes (group size, staff qualifications, organization of care, activities offered, support of religious practice, access to garden, consideration of food preferences) with three levels each. Individuals from the general population between the ages of 50 and 65 years were identified through population registration offices in three rural municipalities and one urban area, and 4390 individuals were approached via postal survey. A hierarchical Bayesian mixed logit model was estimated and interactions with sociodemographic characteristics were investigated. RESULTS A total of 428 and 412 questionnaires were returned by rural and urban respondents, respectively. Access to a garden was perceived as the most important attribute (average importance 36.0% in the rural sample and 33.4% in the urban sample), followed by consideration of food preferences (15.8%, 17.8%), staff qualification (14.6%, 15.3%), care organization (11.4%, 12.3%), group size (12.2%, 11.1%), and range of activities (8.0%, 10.1%). The attribute relating to religious practice was given the least importance (2.1%, 0%). Preferences vary according to gender, age, religious beliefs, experience as an informal caregiver, and migrant background. CONCLUSION Heterogeneous preferences for living arrangements for people with dementia were identified. The expansion of concepts with access to natural environments for persons with dementia might be a viable option for the formal care market in Germany. Further research is needed to meet the challenges of setting up and designing innovative living arrangements for people with dementia. Preferences vary by gender, age, religious beliefs, experience as an informal caregiver, and migrant background.
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Affiliation(s)
- Christian Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
| | - Carina Abels
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Klemens Höfer
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Anja Niemann
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Anke Walendzik
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
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Li Z, Ma Z. Construction and Scale Development of Willingness to Utilize Primary Care Services: A Study from China. Risk Manag Healthc Policy 2023; 16:2171-2185. [PMID: 37881168 PMCID: PMC10595177 DOI: 10.2147/rmhp.s428369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose The willingness to utilize primary care services is crucial in explaining residents' healthcare-seeking behavior and decision-making in the context of the free choice of healthcare providers. This study examines China's family doctor contracting services system to elucidate the conceptual structure of the willingness to utilize primary care services and develop a reliable measurement tool. Methods The study was conducted in two phases. Firstly, in-depth interviews were conducted with community residents, resulting in 42 qualitative data sets. Subsequently, a measurement scale for the willingness to utilize family doctor contracting services was developed, and the scale was validated through two surveys using exploratory factor analysis (N = 250) and confirmatory factor analysis (N = 278), respectively. Results By employing a grounded theory approach, this study analyzes the connotation of willingness to utilize family doctor contracting services. It constructs a conceptual framework for the willingness to utilize primary care services. This conceptual framework consists of three dimensions: perceived feasibility, perceived desirability, and perceived initiative. Based on this framework, a measurement scale comprising 14 items was developed and subjected to rigorous validation procedures to ensure its reliability and validity. Conclusion This study extends prior research on healthcare service utilization willingness by elucidating the internal willingness structure for primary healthcare services. It enhances our understanding of the connotation of healthcare service utilization willingness and develops a scientifically rigorous measurement tool. The findings of this study provide valuable insights into improving both the willingness and behavior of utilizing primary care services in healthcare systems where the hierarchical referral system still needs to be fully developed.
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Affiliation(s)
- Ziyang Li
- School of Management, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Zhiqiang Ma
- School of Management, Jiangsu University, Zhenjiang, People’s Republic of China
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Yan N, Liu T, Xu Y, Fang X, Ma X, Yang M, Du J, Tan Z, Fan EW, Huang J, Akinwunmi B, Zhang CJP, Ming WK, Luo L. Healthcare preferences of the general Chinese population in the hierarchical medical system: A discrete choice experiment. Front Public Health 2022; 10:1044550. [PMID: 36466449 PMCID: PMC9713319 DOI: 10.3389/fpubh.2022.1044550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chinese health insurance system faces resource distribution challenges. A patient-centric approach allows decision-makers to be keenly aware of optimized medical resource allocation. Objective This study aims to use the discrete choice model to determine the main factors affecting the healthcare preferences of the general Chinese population and their weights in the three scenarios (chronic non-communicable diseases, acute infectious diseases, and major diseases). Methods This study firstly identified the key factors affecting people's healthcare preferences through literature review and qualitative interviews, and then designed the DCE questionnaire. An online questionnaire produced by Lighthouse Studio (version 9.9.1) software was distributed to voluntary respondents recruited from mainland China's entire population from January 2021 to June 2021. Participants were required to answer a total of 21 questions of three scenarios in the questionnaire. The multinomial logit model and latent class model were used to analyze the collected data. Results A total of 4,156 participants from mainland China were included in this study. The multinomial logit and latent class model analyses showed that medical insurance reimbursement is the most important attribute in all three disease scenarios. In the scenario of "non-communicable diseases," the attributes that participants valued were, from the most to the least, medical insurance reimbursement (45.0%), hospital-level (21.6%), distance (14.4%), cost (9.7%), waiting time (8.3%), and care provider (1.0%). As for willingness to pay (WTP), participants were willing to pay 204.5 yuan, or 1,743.8 yuan, to change from private hospitals or community hospitals to tertiary hospitals, respectively. Conclusions This study explores the healthcare preferences of Chinese residents from a new perspective, which can provide theoretical reference for the refinement of many disease medical reimbursement policies, such as developing different reimbursement ratios for various common diseases and realizing rational configuration of medical resources.
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Affiliation(s)
- Ni Yan
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Xu
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xuanbi Fang
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xinyang Ma
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Meng Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jianhao Du
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Er-wen Fan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, Boston, MA, United States,Center for Genomic Medicine (CGM), Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States
| | - Casper J. P. Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Wai-Kit Ming
| | - Liangping Luo
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China,Liangping Luo
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Zhou X, He Q, Li Q, Kuang J, Han Y, Chen J. Factors Associated with Outpatient Satisfaction in Provincial Tertiary Hospitals in Nanchang, China: A Structural Equation Modeling Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148226. [PMID: 35886078 PMCID: PMC9351663 DOI: 10.3390/ijerph19148226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
Outpatient satisfaction is important in evaluating the performance of tertiary public hospitals in China. However, only a few studies have examined the interaction between outpatient satisfaction and its related factors. This study aimed to explore the relationship between patient satisfaction and its related factors in provincial tertiary hospitals. Six hundred outpatients in three provincial tertiary hospitals in Nanchang, China, were randomly selected. Structural equation modeling was used to analyze the relationship of the factors associated with outpatient satisfaction. The conceptual model fitted the data well (χ2/df = 4.367, CFI = 0.951, TLI = 0.937, SRMR = 0.055, RMSEA = 0.075), with all the path coefficients being statistically significant (p < 0.001). The environment and facilities showed the most significant influence on outpatient satisfaction (standardized total effect = 0.389), followed by the quality of diagnosis and treatment (standardized total effect = 0.235). The waiting time for medical services showed a partial mediation effect of 0.077 between the environment and facilities and outpatient satisfaction. The study indicates that targeted measures should be taken to improve the amenities of hospitals and shorten the waiting time for medical services, thus further improving outpatients’ medical experience.
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Affiliation(s)
- Xiaojun Zhou
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (X.Z.); (Q.H.); (Q.L.); (J.K.)
| | - Qiuwen He
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (X.Z.); (Q.H.); (Q.L.); (J.K.)
| | - Qi Li
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (X.Z.); (Q.H.); (Q.L.); (J.K.)
| | - Jie Kuang
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (X.Z.); (Q.H.); (Q.L.); (J.K.)
| | - Yalan Han
- Library of Nanchang University, Nanchang University, Nanchang 330006, China;
| | - Jiayan Chen
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (X.Z.); (Q.H.); (Q.L.); (J.K.)
- Correspondence: ; Tel.: +86-0791-86362283
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