Study On Health Service Choice Preference Of Chronic Disease Patients In Community

Research purpose:From the perspective of demander,this study used discrete selection experiments to scientifically measure the preference of chronic patients for primary health services,and estimated the willingness of chronic patients to pay for community health services,in order to provide suggestions for improvement of the existing community chronic disease management.Materials and Methods:The study adopts the method of cross-sectional investigation.A questionnaire survey was conducted in 8 community health service centers in Xindu District,Chengdu from May to August 2022.The questionnaire includes general information questionnaire and discrete choice experiment questionnaire.The statistical software Stata16.0 was used in this study.Descriptive statistical analysis and consistency test analysis were used to construct a mixed Logit model to estimate and analyze the choice preference,willingness to pay and subgroup analysis of patients with chronic diseases on community health services.Results:1.A total of 360 questionnaires were sent out in this survey,360 were collected,and 349 were valid,with effective recovery rate of 96.9%.2.Consistency test resultsA total of 349 patients with chronic diseases were included in the preference analysis.By constructing mixlogit command,the mixed Logit model regression analysis was conducted on the sample size that failed to pass the consistency test for inclusion and exclusion.According to the statistical results of the goodness of fit test,model Ⅱ(excluding patients who did not pass the conformance test)was found to have better goodness of fit than model Ⅰ(including patients who did not pass the conformance test).Therefore,data from 328 patients enrolled in Model II will be analyzed later in this study.3.Regression results of health service choice preference of community chronic disease patientsThe regression results showed that the types of doctors,traditional Chinese medicine services,strong provider services,drug accessibility,appointment and referral services and monthly out-of-pocket costs all had a significant impact on the choice of community health services for patients with chronic diseases.Patients with chronic diseases prefer community health services with general practitioners,traditional Chinese medicine services,longer prescription times,high access to medicines,appointment referrals and lower costs.4.Heterogeneity analysis of health service choice preferences among different populationsAccording to the results of preference heterogeneity analysis based on different demographic characteristics,male patients most valued the service with high access to drugs,while female patients more valued the service with appointment referral.The older the patient,the higher the income and the more chronic diseases,the greater the preference weight for traditional Chinese medicine services;Patients with chronic diseases of different demographic characteristics tended to choose community health services with better access to medicines and referral by appointment.5.Marginal willingness to pay analysisRegression results showed that patients with chronic diseases in the community had the highest willingness to pay for high drug accessibility,followed by appointment and referral services.According to the analysis results of different population characteristics,women’s willingness to pay for traditional Chinese medicine services and appointment and referral services was higher than men’s,and men’s willingness to pay for services with high drug accessibility was the highest.Patients with older age,higher education,higher income,higher self-perceived disease burden,and more chronic diseases are more willing to pay for their preferred health services.Conclusions:1.Six attributes included in this study(types of doctors,traditional Chinese medicine services provided,strong provider services,drug accessibility,appointment and referral,and monthly out-of-pocket costs)had significant effects on the preference of community patients with chronic diseases in choosing health services.In general,the2.attributes that patients with chronic diseases were most concerned about were drug accessibility,appointment referral services,and traditional Chinese medicine services.3.Patients with chronic diseases have heterogeneity in their preferences for community health service selection,and patients with different demographic characteristics have different preferences for community health service selection.4.Patients with chronic diseases are more willing to pay for services with high drug accessibility,and patients are willing to pay more if their demand for drug accessibility can be met.5.The design and optimization of community chronic disease services should not only combine the local practice environment,but also conform to the preferences and wishes of patients,so as to achieve the relatively optimal community chronic disease management mode.