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Exploring determinants of health provider choice and heterogeneity in preference among outpatients in Beijing: a labelled discrete choice experiment

04 Apr 2019

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.

Click here to view the full article which appeared in BMJ Open