Abstract
BackgroundTo 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.MethodsThe 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.ResultsTwo 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.ConclusionsOur 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.
Highlights
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
A standard discrete choice experiment (DCE) consists of five steps: (1) selecting the attributes and levels to be included in the experiment, (2) developing the questionnaire and actual choice tasks presented to respondents, (3) producing a pre-test, (4) collecting data and (5) analysing the discrete choice data
The Lo-Mendell-Rubin test (LMR) test that compared the three-class versus the four-class model achieved a significant level (P < 0.01)
Summary
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. The ratio of total expenditure on health to gross domestic product (GDP) increased from 5.03% in 2009 to 6.36% in 2017. The government’s expenditure on health increased by CNY10–15 billion ($14.55–21.83 billion) per year [1]. Despite the increase in funding, the proportion of outpatient visits at primary healthcare facilities decreased relative to that at tertiary hospitals, and the proportion of hospitalisations at tertiary hospitals increased. Public hospital admissions grew by 11.5% (from 61.7 to 73.1%), while the proportion of services provided by primary healthcare facilities decreased by 7% during the same period [2], suggesting that primary care providers were not effective gatekeepers
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