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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Chengxiang Tang, Judy Xu, Meng Zhang

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Public 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.

Methods

Based 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.

Results

The 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.

Conclusion

Urban 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.
Appendix
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Footnotes
1
Information bias refers to respondents may not be aware of all alternatives in a choice set, or may make associations with other alternatives that are not included. Non-trader bias refers to respondents did not make trade-off between the values of alternatives. Strategic bias refers to respondents uses a heuristic way in choice decisions in which they did not compare all presented alternatives in a choice set simultaneously.
 
2
(nta)/c > =500, where n is the number of respondents, t is the number of tasks, a is number of alternatives per task (not including the none alternative), and c is equal to the largest number of levels for any one attribute.
 
3
CL model allows full covariance among alternatives using a joint normal distribution, in which it assumes that respondents have the same preferences (or that their preferences depend on observable characteristics). MXL model overcomes these limitations by allowing the coefficients in the model to vary across decision makers. Alternatively, the coefficients may be discrete, which leads to the LCM.
 
4
We interpret coefficients as the impact of the attribute’s difference between alternative 1 and alternative 2 on the probability of choosing one over the other. The positive (negative) sign of coefficients reflects whether the attribute level increased (decreased) the likelihood of the alternative to be chosen.
 
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Metadata
Title
The choice and preference for public-private health care among urban residents in China: evidence from a discrete choice experiment
Authors
Chengxiang Tang
Judy Xu
Meng Zhang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1829-0

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