The choice and preference for public-private health care among urban residents in China: evidence from a discrete choice experiment.

Chengxiang Tang,Meng Zhang,Judy Xu

doi:10.1186/s12913-016-1829-0

Abstract

BackgroundPublic health care dominated the services provision in China before 1980s. However, the number of private health care providers in China has been increasing since then. The growth of private hospitals escalated after a market-oriented reform was implemented in 2001. Through an experimental approach, this study aims to a better understanding of the dynamic change in preference of health care utilisation among the residents in urban China.MethodsBased on a discrete choice experiment (DCE) from a random sample of respondents in urban China, the study evaluated preference over health care attributes affecting individuals’ choice for the utilisation of hospital health care. The marginal willingness-to-pay for five health care attributes was estimated, including public/private provision of health care, by analysing mixed logit and latent class models.ResultsThe results indicated a significantly negative marginal willingness-to-pay for private health care, which was interpreted as representing people’s previous interactions with the health care system. The latent class model further suggested preference heterogeneity across our sample. We found that Hukou type, a typical indicator of socioeconomic background, was significantly related to respondents’ preference for health care utilisation. Permanent urban residents (urban Hukou) valued private health care less; in contrast rural migrants (rural Hukou) were more likely to be indifferent between public/private provision.ConclusionUrban residents in China showed a high disposition to obtain health care from the public providers of health care. Our results have implications in the context of the Chinese government attempts to expand the private health care sector in the short term. Policy makers need to consider residents’ preference for health care in health policy development as the preference can only change in the long term.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1829-0) contains supplementary material, which is available to authorized users.

Highlights

Public health care dominated the services provision in China before 1980s
Faced with a rise in the demand for health care and a long waiting-list in public hospitals, the government has applied a series of market-oriented policies to endorse the development of a private hospital sector since 2000, which has resulted in a rapid increase in the number of private hospitals in China [2, 3]
In conclusion, this paper first applied a discrete choice experiment to value the attributes of health care, including public/private provision of health care, in the context of growing private hospitals in China

Summary

Introduction

The number of private health care providers in China has been increasing since . Faced with a rise in the demand for health care and a long waiting-list in public hospitals, the government has applied a series of market-oriented policies to endorse the development of a private hospital sector since 2000, which has resulted in a rapid increase in the number of private hospitals in China [2, 3]. Most of the published literature investigating the demand for private health care providers among the range of provider choices is from high-income settings, we are aware of some studies completed in middle-or-low-income countries [5,6,7]. The private hospital sector in China is substantially underdeveloped in contrast to it in developed countries [1]

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