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Nouwens SPH, Marceta SM, Bui M, van Dijk DMAH, Groothuis-Oudshoorn CGM, Veldwijk J, van Til JA, de Bekker-Grob EW. The Evolving Landscape of Discrete Choice Experiments in Health Economics: A Systematic Review. PHARMACOECONOMICS 2025:10.1007/s40273-025-01495-y. [PMID: 40397369 DOI: 10.1007/s40273-025-01495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2025] [Indexed: 05/22/2025]
Abstract
INTRODUCTION Stakeholder preference evaluations are increasingly emphasized in healthcare policy and health technology assessment. Discrete choice experiments (DCEs) are the most common method for quantifying preferences among patients, the public, and healthcare professionals. While prior reviews (1990-2017) have examined DCE trends, no comprehensive synthesis exists for studies published since 2018. This updated review (2018-2023) provides critical insights into evolving methodologies and global trends in health-related DCEs. METHODS A systematic search (2018-2023) of Medline, Embase, and Web of Science identified relevant studies. Studies were screened for inclusion and data were extracted, including details on DCE design and analysis. To enable trend comparisons, the search strategy and extraction items aligned with previous reviews. RESULTS Of 2663 identified papers, 1279 met the inclusion criteria, reflecting a significant rise in published DCEs over time. DCEs were conducted globally, with a remarkable increase in publications from Asia and Africa compared with previous reviews. Experimental designs and econometric models have advanced, continuing prior trends. Notably, most recent DCEs were administered online. DISCUSSION The rapid growth of DCE applications underscores their importance in health research. While the methodology is advancing rapidly, it is crucial that researchers provide full transparency in reporting their methods, particularly in detailing experimental designs and validity tests, which are too often overlooked. Key recommendations include improving reporting of experimental designs, applying validity tests, following good practices for presenting benefit-risk attributes, and adopting open science practices. Ensuring methodological rigor will maximize the impact and reproducibility of DCE research in health economics.
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Affiliation(s)
- Sven Petrus Henricus Nouwens
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands.
| | - Stella Maria Marceta
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Daisy Maria Alberta Hendrika van Dijk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | | | - Jorien Veldwijk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Janine Astrid van Til
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Esther Wilhelmina de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
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Su J, Gu Y, Yuan J, Tian B, Liu S, Yu H, Wang Y, Sun L, Zhang Y, He D. Analysis of factors influencing attrition among clinical traditional Chinese medical major graduates: based on a discrete choice experiment. Arch Public Health 2025; 83:54. [PMID: 40001268 PMCID: PMC11852512 DOI: 10.1186/s13690-025-01539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 02/10/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Traditional Chinese Medicine (TCM) is essential for promoting health worldwide. Despite governmental support, TCM faces critical challenges, including workforce shortages and high attrition rates, with many clinical TCM graduates pursuing non-clinical careers. This study aims to explore the employment preferences of these graduates and to propose strategies for retaining TCM professionals, optimizing the input-output ratio of TCM education, and supporting the sustainable development of the TCM industry. METHODS A stratified sampling method was used to select clinical TCM major graduates from 16 universities of Chinese medicine. A Discrete Choice Experiment (DCE) was conducted to investigate the factors influencing the attrition of clinical TCM professionals, including monthly income, work location, housing security, workload, work environment, and promotion opportunities. A mixed logit model was applied to analyze the DCE data. RESULTS A total of 273 clinical TCM major graduates were included in the primary DCE analysis. The monthly income was more important than other attributes (RAI = 48.03%). Among non-economic factors, participants expressed the strongest willingness to decrease workload, being willing to forgo 3,370.312 yuan (approximately $500.3) in monthly income to reduce heavy workloads to moderate levels. Other significant factors included work environment (RAI = 13.64%), housing security (RAI = 9.47%), and promotion opportunities (RAI = 5.33%), with work location being the least important (RAI = 3.3%). Subgroup analysis showed that rural graduates were more willing than urban graduates to forgo monthly income for promotion opportunities. Graduates from the central region of China valued work environment and housing security more than those from the eastern and western regions. Postgraduates were more likely than undergraduates to give up monthly income for housing security. CONCLUSION In addition to economic factors, non-economic factors are also critical considerations for clinical TCM major graduates in their employment decisions. A combination of measures, including offering lower workloads, better work environments, housing security, and promotion opportunities, should be adopted to stabilize the employment environment for clinical TCM graduates.
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Affiliation(s)
- Jinying Su
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yichun Gu
- Shanghai Health Development Research Center, Shanghai, China
| | - Jiaqi Yuan
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University), Jinan, China
| | - Botao Tian
- School of Economics and Management, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Shimeng Liu
- School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Economics and Policy Research, Fudan University), Shanghai, China
| | - Huaxin Yu
- Disease Control and Prevention Center of Jinpu New Area, Dalian, China
| | - Yaqun Wang
- School of Public Health, Dalian Medical University, Dalian, China
| | - Lihang Sun
- Institution of Global Health, University College London, London, UK
| | - Yulin Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Da He
- Shanghai Health Development Research Center, Shanghai, China.
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Gu Y, Tian B, Wu S, Liu S, Sun L, Wang Y, Yu H, Zhang Y, Su J, He D. Job preferences among traditional Chinese medicine clinical graduates in China: a discrete choice experiment. BMC MEDICAL EDUCATION 2025; 25:272. [PMID: 39979980 PMCID: PMC11841246 DOI: 10.1186/s12909-025-06841-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 02/07/2025] [Indexed: 02/22/2025]
Abstract
BACKGROUND Primary-level Traditional Chinese Medicine (TCM) healthcare institutions are currently facing a severe shortage of TCM professionals, highlighting the urgent need to explore the job preferences of TCM clinical graduates. This study aimed to investigate the stated job preferences of TCM clinical graduates when seeking employment. METHODS A discrete choice experiment (DCE) was conducted to assess the employment preferences of TCM clinical graduates from 16 TCM universities across China. The job attributes examined included the monthly income, work location, hospital tier, job stability (position tenure), work intensity, opportunities for mentorship under renowned practitioners, and career advancement prospects. A mixed logit model was employed to obtain the main effects model. Based on the results of the main effects model, analyses of relative importance and willingness to pay (WTP) were conducted. Additionally, heterogeneity analysis and scenario simulation analysis were performed. RESULTS A total of 2,402 valid questionnaires were included in the primary DCE analysis. Monthly income was the most important factor (RIS = 52.58%). Among non-economic factors, participants expressed the strongest willingness to reduce workload, being willing to forgo 2,367.5 yuan in monthly income to transition from high to low work intensity. Other significant factors included formal establishment (RIS = 11.32%), mentorship opportunities (RIS = 7.44%), and hospital level (RIS = 4.63%), with job location being the least important (RIS = 3.44%). Subgroup analysis showed that male graduates were more willing than female graduates to forgo formal establishment for mentorship opportunities. Graduates from the eastern region valued lower work intensity and formal establishment more than those from the central and western regions. Postgraduates were more likely than undergraduates to give up monthly income for jobs in higher-tier cities. Scenario analysis revealed that graduates had a 43.0% probability of choosing third-tier cities under baseline conditions. Comprehensive improvements (e.g., higher income and formal establishment) increased this probability to 84.8%, rising to 87.3% with better promotion opportunities. CONCLUSION This study demonstrates that the monthly income has the most significant impact on employment preferences. The work intensity and mentorship opportunities also play crucial roles, with the influence of the work intensity surpassing those of other non-economic factors. In contrast, the hospital tier and work location have a relatively smaller impact on graduates' preferences. In addition, a combination of certain non-economic measures can enhance students' willingness to choose hospitals in third-tier cities. Based on these findings, it is recommended that recruitment and career development strategies focus on the salary, work intensity, and mentorship opportunities, while providing stable job positions and favorable work environments, so as to meet the primary needs of TCM clinical graduates. A novel contribution of this study is its identification of the significant influence of mentorship opportunities, which are one of the distinctive features of TCM, on the employment choices of TCM graduates, filling a gap in the existing research. Future studies should integrate online questionnaires with offline interviews to gain deeper insights into the decision-making processes of graduates in real-world work environments.
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Affiliation(s)
- Yichun Gu
- Shanghai Health Development Research Center, Shanghai, China
| | - Botao Tian
- School of Economics and Management, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Shang Wu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shimeng Liu
- School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Economics and Policy Research, Fudan University, Shanghai, China
| | - Lihang Sun
- Institution of global health, University College London, London, UK
| | - Yaqun Wang
- School of Public Health, Dalian Medical University, Dalian, Liaoning, China
| | - Huaxin Yu
- Disease Control and Prevention Center of Jinpu New Area, Dalian, Liaoning, China
| | - Yulin Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jinying Su
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Da He
- Shanghai Health Development Research Center, Shanghai, China.
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Gong H, Li Y, Duan W, Chen Y, Zhou J, Cao S. Career choices and career mobility of chinese pharmacy graduates: a cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:1440. [PMID: 39696206 DOI: 10.1186/s12909-024-06448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 12/03/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND This study investigates the career mobility and employment status of Chinese pharmacy graduates, aiming to address workforce challenges and career planning within the pharmacy profession. Given the rapid expansion of the healthcare sector in China, understanding factors influencing job changes and career decisions is crucial for ensuring workforce stability and professional development. The study covers pharmacy graduates enrolled at Kunming Medical University from 1996 to 2012. METHODS A cross-sectional online survey collected data from 231 respondents in April 2022, focusing on demographic characteristics, career choices, job changes, and the factors influencing these decisions. Multivariate logistic regression and Chi-square (χ²) tests were used to analyze the data, with a particular focus on the pharmacy practice, pharmaceutical sciences, and clinical pharmacy. RESULTS Of the 231 respondents, 52.4% (n = 121) had never changed jobs, and 32.5% (n = 75) had changed jobs once or twice. The majority preferred working in governmental institutions (n = 146, 63.2%), with fewer graduates choosing domestic (n = 48, 20.8%) or overseas pharmacy enterprises (n = 20, 8.7%). Income and personal growth were significant factors influencing job changes (p < 0.05). Respondents who had changed jobs three or more times placed a greater emphasis on personal growth (Relative Risk Ratio [RRR]: 2.96; 95% Confidence Interval [CI]: [1.6, 5.49]). CONCLUSIONS This study reveals significant variations in job mobility and career choices among Chinese pharmacy graduates. Graduates in governmental institutions showed lower mobility, while those in pharmacy enterprises and non-pharmaceutical sectors experienced higher job changes. Income, personal growth, and work environment were key factors.
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Affiliation(s)
- Hongyu Gong
- Technology Achievement Transformation Center , Kunming Medical University, Chunrong West Road 1168, Kunming City, China
| | - Yan Li
- The Third Primary School in Chenggong District, No. 1246, Ruixiang West Street, Kunming City, China
| | - Wenyue Duan
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Chunrong West Road 1168, Kunming City, China
| | - Ying Chen
- Faculty of Humanities and Management, Kunming Medical University, Chunrong West Road, Kunming City, 1168, China
| | - Jianyu Zhou
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Chunrong West Road 1168, Kunming City, China.
- College of Modern Biomedical Industry, Kunming Medical University, Chunrong West Road, Kunming City, 1168, China.
| | - Shuming Cao
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Chunrong West Road 1168, Kunming City, China.
- College of Modern Biomedical Industry, Kunming Medical University, Chunrong West Road, Kunming City, 1168, China.
- Kunming Medical University, Chunrong west road 1168, Kunming City, China.
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Cheng H, Tian R, Chen D, Shang J, Gao L, Dong X, Guo B, Liu G. Job preferences of master public health candidates in Northeast China based on discrete choice experiments. BMC Health Serv Res 2024; 24:1291. [PMID: 39468610 PMCID: PMC11520076 DOI: 10.1186/s12913-024-11810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 10/21/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND The shortage of health workers in rural and remote areas is a key issue for global health systems, including China. Public health undertakings in Northeast China face the risk of a talent gap. In September 2023, the National Development and Reform Commission (NDRC) held a symposium on promoting the comprehensive revitalization of Northeast China in the New Era, proposing to support the comprehensive revitalization of Northeast China with high-quality population development, strengthen the development and utilization of human resources, and increase policy support for the revitalization of talent. METHODS The questionnaire was designed by discrete choice experiments, and 1208 Public Health Master's candidates from six universities in Northeast China were investigated online via the Powercx system network survey platform in April 2024. The mixed logit model was used to analyze the job preferences of Master Public Health candidates. RESULTS All 7 attributes included in the study had statistically significant effects on the job preferences of public health master's degree candidates (P < 0.05). They tended to choose jobs with higher monthly income (12,000 CNY/month), located in cities with good working environments and with Bianzhi when seeking jobs. There is heterogeneity in job preference, and different preference characteristics are displayed in different subgroups. CONCLUSION This study revealed that public health master's degree candidates in Northeast China were more willing to choose jobs with higher monthly incomes, working places in cities and better working environments. The way to formulate a combination of policy packages is more attractive than improving a single aspect alone. Since the preferences of each subgroup are different, the preference characteristics of the target population should also be considered when formulating the policy package to meet the challenges of talent attraction and retention.
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Affiliation(s)
- Huaizhi Cheng
- Harbin Medical University-Daqing, Daqing, 163319, China
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China
| | - Ruotong Tian
- Harbin Medical University-Daqing, Daqing, 163319, China
| | - Dongquan Chen
- Quanzhou Hospital of Traditional Chinese medicine, No.388, Sunjiang Road, Jiangnan District, Quanzhou, China
| | - Jiesen Shang
- Zhongshan Hospital, Xiamen University, No.201-209 Hubinnan Road, Siming District, Xiamen, China
| | - Lingxiao Gao
- Harbin Medical University-Daqing, Daqing, 163319, China
| | - Xiaoyu Dong
- Harbin Medical University-Daqing, Daqing, 163319, China
| | - Bin Guo
- Harbin Medical University-Daqing, Daqing, 163319, China.
| | - Guoxiang Liu
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China.
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Shi K, Wang Y, Sun Z, Zhao J, Xiang F, Chen Z, Sun W, Zheng Y. Turnover behavior and intention among dentists and medical doctors: a cross-sectional study in China. BMC Oral Health 2024; 24:180. [PMID: 38311735 PMCID: PMC10840253 DOI: 10.1186/s12903-024-03903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Retention of doctors is a global challenge and doctors working in different departments may face different problems. The study aimed to explore the turnover behavior and intention and correlated factors among Chinese dentists and medical doctors in other clinical fields. METHODS A cross-sectional study was conducted online in 5 regions of China from March 12th to April 12th, 2020. The questionnaire included 3 parts, socio-demographic characteristics, turnover behavior and intention, and concerns about work-related factors. Chi-square test and/or Wilcoxon Mann-Whitney test were applied for comparison, and binary logistic regression was used for finding the factors. RESULTS A total of 2428 eligible questionnaire were received, comprising 1954 responses from dentists and 474 from medical doctors. Rates of turnover behavior among dentists and medical doctors were 2.87% and 6.96%, respectively. Similarly, rates of turnover intention were 51.79% among dentists and 71.20% among medical doctors. Educational level was negatively correlated with turnover behavior of both medical doctors and dentists, and concern about salary was a unique negatively correlated factor for dentists. Age was negatively correlated with turnover intention in both medical doctors and dentists. Conversely, concerns about workload and doctor-patient relationship were positively correlated with turnover intention in both groups. Concern about salary was the distinct correlated factor of medical doctors' turnover intention, while gender and annual household income were correlated with turnover intention among dentists. CONCLUSIONS Low turnover rate but high turnover intention rate was the current status of Chinese doctors' employment. Turnover behavior and intention were more optimistic among dentists than medical doctors. Factors related to turnover behavior and turnover intention were not identical among dentists and medical doctors. Therefore, personalized retention measures were necessary for dentists and medical doctors.
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Affiliation(s)
- Keying Shi
- School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yong Wang
- Department of Stomatology, Shangcheng District Jiubao Community Health Center of Hangzhou City, Hangzhou, Zhejiang, China
| | - Zhe Sun
- School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jing Zhao
- School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fangyue Xiang
- School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhi Chen
- School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenjing Sun
- School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuanna Zheng
- School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Ningbo Dental Hospital/Ningbo Oral Health Research Institute, Ningbo, Zhejiang, China
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Luo N, Bai R, Sun Y, Li X, Liu L, Xu X, Liu L. Job preferences of master of public health students in China: a discrete choice experiment. BMC MEDICAL EDUCATION 2024; 24:24. [PMID: 38178052 PMCID: PMC10768294 DOI: 10.1186/s12909-023-04993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The shortage of public health personnel and the uneven distribution between urban and rural areas are thorny issues in China. Master of public health (MPH) is an integral part of public health human resources in the future, and it is of far-reaching significance to discuss their work preferences. The present study wants to investigate the job preference of MPH, understand the relative importance of different job attributes, and then put forward targeted incentive measures. METHODS Discrete choice experiment (DCE) was used to evaluate the job preference of MPHs in two medical colleges in Liaoning Province. Attributes include employment location, bianzhi, working environment, career development prospects, work value and monthly income. Thirty-six choice sets were developed using a fractional factorial design. Mixed logit models were used to analysis the DCE data. RESULTS The final sample comprised 327 MPHs. All the attributes and levels included in the study are statistically significant. Monthly income is the most important factor for MPHs. For non-economic factors, they value career development prospects most, followed by the employment location. Respondents' preferences are heterogeneous and influenced by individual characteristics. Subgroup analysis showed that respondents from different family backgrounds have different job preferences. Policy simulation suggested that respondents were most sensitive to a salary increase, and the combination of several non-economic factors can also achieve the same effect. CONCLUSIONS Economic factors and non-economic factors significantly affect the job preference of MPHs. To alleviate the shortage and uneven distribution of public health personnel, more effective policy intervention should comprehensively consider the incentive measures of the work itself and pay attention to the individual characteristics and family backgrounds of the target object.
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Affiliation(s)
- Nansheng Luo
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Ru Bai
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Yu Sun
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Xueying Li
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Libing Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Xin Xu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110004, Shenyang, Liaoning, China.
| | - Li Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China.
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Tian Z, Guo W, Zhai M, Li H. Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China. BMC MEDICAL EDUCATION 2023; 23:890. [PMID: 38012762 PMCID: PMC10680353 DOI: 10.1186/s12909-023-04873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Public health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students' preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute. METHODS Based on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students' stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute. RESULTS A total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students' WTP for a job located in the county or city is much lower than that of urban students. CONCLUSIONS The heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.
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Affiliation(s)
- Zhuang Tian
- School of Public Health, Jining Medical University, Jining, 272067, China
| | - Wei Guo
- Public Health Service Center in Rencheng District, Jining, 272412, China
| | - Min Zhai
- School of Public Health, Jining Medical University, Jining, 272067, China
| | - Hongmin Li
- School of Public Health, Jining Medical University, Jining, 272067, China.
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Wu M, Li Y, Ma C. Patients' choice preferences for specialist outpatient online consultations: A discrete choice experiment. Front Public Health 2023; 10:1075146. [PMID: 36684861 PMCID: PMC9850164 DOI: 10.3389/fpubh.2022.1075146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background Internet hospitals are multiplying with solid support from the Chinese government. In internet hospitals, specialist outpatient online consultations (SOOC) are the primary services. However, the acceptance and utilization rates of this service are still low. Thus, the study of patients' choice preferences for SOOC is needed. Objective To analyze the choice preference of patients' SOOC via a discrete choice experiment, understand the influence of each factor and promote the development of internet hospitals. Methods Via a discrete selection experiment, a total of 162 patients from two general hospitals and three specialized hospitals in Beijing were selected for the questionnaire survey. The choice preferences were analyzed by conditional logit regression. Results From high to low, patients' willingness to pay (WTP) for the attributes of SOOC is as follows: doctors' recommendation rate (β highly recommend = 0.999), the convenience of applying SOOC services (β Convenient = 0.760), the increasing ratio of medical insurance payment for online services compared to offline (β Increase by 10% = 0.545), and the disease's severity (β severe = -3.024). The results of the subgroup analysis showed differences in patient choice preference by age, whether the patients had chronic diseases, income, and medical insurance types. Conclusion Both price and nonprice attributes influence the choice preference of SOOC for patients. Among them, patients are more inclined to choose SOOC when doctors highly recommend it, when it is convenient to apply, when medical insurance increases by 10%, and when disease severity is mild. The current findings show the government and medical institutions formulate auxiliary policies and welfare strategies by clarifying core attributes and adjusting the levels of different attributes to improve patients' acceptance of SOOC. The utility of SOOC and the further development of internet hospitals are radically promoted.
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Affiliation(s)
- Mengqiu Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuhan Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Chengyu Ma
- School of Public Health, Capital Medical University, Beijing, China
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Liu S, Gu Y, Yang Y, Schroeder E, Chen Y. Tackling brain drain at Chinese CDCs: understanding job preferences of public health doctoral students using a discrete choice experiment survey. HUMAN RESOURCES FOR HEALTH 2022; 20:46. [PMID: 35606873 PMCID: PMC9125964 DOI: 10.1186/s12960-022-00743-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China. METHODS A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children's education opportunities, working environment, career promotion speed and bianzhi (formally established post). RESULTS A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed). CONCLUSION Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.
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Affiliation(s)
- Shimeng Liu
- School of Public Health, Fudan University, 130 Dongan Rd, Xuhui, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Macquarie Park, NSW 2109 Australia
| | - Yi Yang
- School of Public Health, Fudan University, 130 Dongan Rd, Xuhui, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
| | - Elizabeth Schroeder
- Centre for the Health Economy, Macquarie University, Macquarie Park, NSW 2109 Australia
- Department of Health Systems and Populations, Macquarie University, Macquarie Park, NSW 2109 Australia
| | - Yingyao Chen
- School of Public Health, Fudan University, 130 Dongan Rd, Xuhui, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
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Shi Z, Li S, Chen G. Assessing the Psychometric Properties of the Chinese Version of Ten-Item Personality Inventory (TIPI) Among Medical College Students. Psychol Res Behav Manag 2022; 15:1247-1258. [PMID: 35603350 PMCID: PMC9121988 DOI: 10.2147/prbm.s357913] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The Ten-Item Personality Inventory (TIPI) was designed as a brief instrument of the Big Five personality traits. This study aimed to explore the internal consistency and structural validity of the Chinese version of TIPI (TIPI-C) in medical college students. Methods A cross-sectional study was conducted in 11 provinces of China. Spearman–Brown coefficient, standardized Cronbach’s α coefficient, and Cronbach’s α coefficient were applied to estimate the internal consistency. Spearman–Brown coefficient was applied to estimate split-half reliability. Principal components analysis (PCA) and confirmatory factor analysis (CFA) were used to identify the structural validity. Results A total of 2223 medical college students recruited from different regions of China were included. The Spearman–Brown coefficients of TIPI-C ranged from 0.129 to 0.786 and the Cronbach’s α coefficients ranged from 0.119 to 0.785. The split-half reliability of the Spearman–Brown coefficient was 0.508. The latent structure of Extraversion, Emotional Stability, and Conscientiousness complied with the intended structure, and the internal consistency coefficients of these three traits were supported. However, the internal consistency coefficients of Agreeableness and Openness were low and the structural validity was not supported. Conclusion TIPI-C primarily stands out as a feasible instrument for brief measurements of the Extraversion, Emotional Stability, and Conscientiousness domains. Further research is required to evaluate the concurrent validity and the test–retest reliability of TIPI-C in different populations and potentially modify the instrument to be more suitable for the Chinese population.
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Affiliation(s)
- Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, Shandong, People’s Republic of China
- Center for Health Preference Research, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, Shandong, People’s Republic of China
- Center for Health Preference Research, Shandong University, Jinan, Shandong, People’s Republic of China
- Centre for Quality of Life and Public Policy Research, Shandong University, Jinan, Shandong, People’s Republic of China
- Correspondence: Shunping Li, Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Road 44, Jinan, 250012, Shandong, People’s Republic of China, Tel +86-131-8893-4998, Email
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
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Liu C, Wu Q, Liang Z, Karimi L, Ferrier JA, Sheats J, Khalil H. Adaptation strategies in transnational education: a case study of an australian Master of Health Administration Course offered to chinese managers. BMC MEDICAL EDUCATION 2022; 22:52. [PMID: 35065649 PMCID: PMC8783661 DOI: 10.1186/s12909-021-03097-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Management decisions in health influence patient care outcomes; however, health management development courses in China are rare. This study aims to document and evaluate a transnational Master of Health Administration (MHA) course launched in 2000 for the benefit of Chinese health managers. METHODS A case study of the MHA program jointly run by an Australian university and a Chinese Medical University was conducted. We reviewed the development of the MHA course through a document analysis (key events recorded in achieves, minutes, and audits) followed by reflection (by two course coordinators), extracting key themes related to adaptative strategies. We then conducted a questionnaire survey of 139 graduates seeking their views on relevance, satisfaction and challenges associated with each subject within the course, the relevance of key management skills (as determined by the Australasian College of Health Service Management competency framework), and the impact of the course on their personal career trajectories. Chi-square tests identified differences in the responses by age, gender, pre-training position, and current workplace. RESULTS The curriculum pedagogy followed the principles of practice-based reflective learning. Research findings and student feedback shaped the curriculum design and subject content, to enhance management practices of the students. Survey participants expressed high levels of satisfaction and confirmed the relevance of all study subjects. Two subjects, health economics and data management, were perceived as being the most challenging. Of the ten management skills we assessed, relatively low self-rated confidence was found in "strategic thinking" and "planning". Younger and less experienced graduates were more likely to report learning challenges (p < 0.05). Frontline managers were least likely to obtain promotion by changing employers (χ2 = 6.02, p < 0.05) or being seconded to another position (χ2 = 9.41, p < 0.01). CONCLUSIONS This case study illustrates the suitability of cross-country partnerships in health management training, which offers opportunities for managers to systematically explore and acquire a comprehensive set of management skills applicable to their career needs. Opportunities for developing training aligned to career development opportunities are critical for attracting and developing a competent and well-prepared health service management workforce in China.
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Affiliation(s)
- Chaojie Liu
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - Qunhong Wu
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
- School of Health Management, Harbin Medical University, 150081 Harbin Heilongjiang, China
| | - Zhanming Liang
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 4811 Townsville, Qld Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - J. Adamm Ferrier
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - Jane Sheats
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
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What Are the Important Factors Influencing the Recruitment and Retention of Doctoral Students in a Public Health Setting? A Discrete Choice Experiment Survey in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189474. [PMID: 34574396 PMCID: PMC8467983 DOI: 10.3390/ijerph18189474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
Objectives: This study aims to investigate the employment preferences of doctoral students majoring in social medicine and health care management (SMHCM), to inform policymakers and future employers on how to address recruitment and retention requirements at CDCs across China. Methods: An online discrete choice experiment (DCE) was conducted to elicit doctoral SMHCM students’ job preferences. The scenarios were described with seven attributes: monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed, and bianzhi. A conditional logit model and a mixed logit model were used to evaluate the relative importance of the selected attributes. Results: A total of 167 doctoral SMHCM students from 24 universities completed the online survey. All seven attributes were statistically significant with the expected sign and demonstrated the existence of preference heterogeneity. Monthly income and employment location were of most concern for doctoral SMHCM students when deciding their future jobs. Among the presented attributes, working environment was of least concern. For the sub-group analysis, employment located in a first-tier city was more likely to lead to a higher utility value for doctoral students who were women, married, from an urban area, and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. Conclusions: Our study suggests that monthly income and employment location were valued most by doctoral SMHCM students when choosing a job. A more effective human resource policy intervention to attract doctoral SMHCM students to work in CDCs, especially CDCs in third-tier cities should consider both the incentives provided by the job characteristics and the background of students. Doctoral students are at the stages of career preparation, so the results of this study would be informative for policymakers and help them to design the recruitment and retention policies for CDCs.
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Liu P, Liu S, Gong T, Li Q, Chen G, Li S. Job preferences of undergraduate pharmacy students in China: a discrete choice experiment. HUMAN RESOURCES FOR HEALTH 2021; 19:79. [PMID: 34229701 PMCID: PMC8259344 DOI: 10.1186/s12960-021-00626-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/29/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Pharmacists are a crucial part of the health workforce and play an important role in achieving universal health coverage. In China, pharmaceutical human resources are in short supply, and the distribution is unequal. This study aimed to identify the key job characteristics that influence the job preferences of undergraduate pharmacy students and to elicit the relative importance of different job characteristics to shed light on future policy interventions. METHODS A discrete choice experiment was conducted to assess the job preferences of undergraduate pharmacy students from 6 provinces in mainland China. A face-to-face interview was used to collect data. Conditional logit and mixed logit models were used to analyse data, and the final model was chosen according to the model fit statistics. A series of policy simulations was also conducted. RESULTS In total, 581 respondents completed the questionnaire, and 500 respondents who passed the internal consistency test were analysed. All attributes were statistically significant except for open management. Monthly income and work location were most important to respondents, followed by work unit (which refers to the nature of the workplace) and years to promotion. There was preference heterogeneity among respondents, e.g., male students preferred open management, and female students preferred jobs in public institutions. Furthermore, students with an urban background or from a single-child family placed higher value on a job in the city compared to their counterparts. CONCLUSION The heterogeneity of attributes showed the complexity of job preferences. Both monetary and nonmonetary job characteristics significantly influenced the job preferences of pharmacy students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both incentives on the job itself and the background of pharmacy school graduates.
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Affiliation(s)
- Ping Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
- Centre for Health Preference Research, Shandong University, Jinan, 250012 China
| | - Shimeng Liu
- School of Public Health, Fudan University, Shanghai, 200032 China
- NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032 China
| | - Tiantian Gong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
- Centre for Health Preference Research, Shandong University, Jinan, 250012 China
| | - Quan Li
- Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, 3145 Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
- Centre for Health Preference Research, Shandong University, Jinan, 250012 China
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Jia E, Gu Y, Peng Y, Li X, Shen X, Jiang M, Xiong J. Preferences of Patients with Non-Communicable Diseases for Primary Healthcare Facilities: A Discrete Choice Experiment in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113987. [PMID: 32512772 PMCID: PMC7311994 DOI: 10.3390/ijerph17113987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
Objectives: To elicit stated preferences of patients with non-communicable diseases (NCDs) for primary healthcare (PHC) facilities and to explore the willingness-to-pay (WTP) for facility attributes. Methods: A discrete choice experiment (DCE) was conducted through face to face interviews. The DCE survey was constructed by five attributes: type of service, treatment measures, cost, travel time, and care provider. Patients’ preferences and willingness to pay for facility attributes were analyzed using a mixed logit model, and interaction terms were used to assess preference heterogeneity among patients with different sociodemographic characteristics. Results: Patients placed different weights on attributes, depending on whether they perceived their health condition as minor or severe. For conditions perceived as minor, patients valued treatment measures (56.60%), travel time (32.34%) and care provider (8.51%) most. For conditions perceived as severe, they valued treatment measures (52.19%), care provider (38.69%), and type of service (7.30%) most. The WTP related to the change from Traditional Chinese Medicine (TCM) service to Modern Medicine (MM) service was the largest for both severity scenarios. For conditions perceived as minor, patients would be willing to pay 102.84 CNY (15.43 USD) for a reduction in travel time to below 30 min. For conditions perceived as severe, WTP related to the change from general service to specialized service and from junior medical practitioner to senior medical practitioner, were highly valued by respondents, worth 107.3 CNY (16.10 USD) and 565.8 CNY (84.87 USD), respectively. Conclusions: Factors related to the provision of PHC, such as treatment measures, care provider and type of service were highly valued. The findings could contribute to the design of better PHC delivery, improve the participation of patients in PHC, and provide some evidence to promote shared decision-making.
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Affiliation(s)
- Erping Jia
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; (E.J.); (Y.P.); (X.L.); (X.S.); (M.J.)
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW 2109, Australia;
| | - Yingying Peng
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; (E.J.); (Y.P.); (X.L.); (X.S.); (M.J.)
| | - Xianglin Li
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; (E.J.); (Y.P.); (X.L.); (X.S.); (M.J.)
| | - Xiao Shen
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; (E.J.); (Y.P.); (X.L.); (X.S.); (M.J.)
| | - Mingzhu Jiang
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; (E.J.); (Y.P.); (X.L.); (X.S.); (M.J.)
| | - Juyang Xiong
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; (E.J.); (Y.P.); (X.L.); (X.S.); (M.J.)
- Correspondence:
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