Jiang Ming-Zhu, Fu Qiang, Xiong Ju-Yang, Li Xiang-Lin, Jia Er-Ping, Peng Ying-Ying, Shen Xiao
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
BMC Health Serv Res. 2020 May 18;20(1):430. doi: 10.1186/s12913-020-05134-4.
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. 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.
The 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.
Two 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.
Our 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.
为解决中国基层医疗服务利用率低的问题，使资源分配与社区居民的偏好相匹配至关重要。目前国内鲜有描述居民对医疗服务感知特征的学术研究。本研究旨在调查社区居民对医疗服务利用的偏好，并探讨其异质性。研究结果将有助于政策制定者采取针对性措施来调整医疗服务的提供。
通过面对面访谈和调查，获取社区居民对医疗服务利用偏好的四个关键属性（医疗服务提供者；服务模式；成本；出行时间）。首先进行合理性测试以确认一致性，然后向受访者给出16对包含12个社会人口学项目的选择任务。每个选择任务中有两个假设选项，且无退出选项。采用潜在类别分析（LCA）对数据进行分析。
我们的研究招募了来自6个城市36个社区的2160名受访者。2019名（93.47%）受访者完成了有效的离散选择实验（DCE）问卷。LCA结果表明识别出了四组相似的偏好。第一组（27.29%）被标记为“综合考量型”，对所有四个属性偏好较为均衡。第二组（37.79%）被标记为“价格驱动型”，偏好低价医疗服务。第三组被标记为“距离近优先型”，明显偏好就近寻求医疗服务。第四组（34.18%）被标记为“追求质量型”，偏好专家提供的医疗服务。支付意愿（WTP）结果显示，人们愿意为中医服务支付202.12元人民币（29.37美元），愿意为专家提供的服务支付604.31元人民币（87.81美元）。
我们的研究定性地衡量了中国社区居民对医疗服务利用的不同偏好。结果表明，在优先级设定决策中应考虑医疗服务提供者、服务模式、出行时间和成本。然而，研究揭示了不同人群亚组在中医观点上存在重大分歧。
