Inpatient preference among patients with multiple chronic conditions in China: a discrete choice experiment

Abstract

Abstract Background Multiple chronic conditions (MCC) have become a leading cause of hypovitalism and death among the population. Although the role of chronic disease management has been strengthened for primary health institutions, patients still have a preference for a higher level of inpatient service, leading to a considerable hindrance in the efficient utilization of healthcare resources. Thus, this study aimed to identify factors that affected MCC patients' inpatient preference and the extent to which these factors impact their decisions, guiding for inpatient service utilization among MCC patients. Methods Five attributes (institutional scale, waiting time for hospital admission, with or without acquaintances, time from residence to hospital, out-of-pocket expenses per time) were identified to estimate inpatient choice for MCC patients through a discrete choice experiment. Partial factor analysis was performed to generate selection sets. Data were collected from MCC patients between 35 and 75 years old, in Fuqing, Fujian Province. A mixed logit model was performed to analyze MCC patients' preferences for each attribute. Willingness to pay was estimated by regression coefficients, and subgroup analysis was conducted based on the patient’s demographic characteristics and overall perceived disease severity. Results Totally 504 valid questionnaires were included in the analysis. MCC patients preferred to have a shorter time from their residence to the hospital (β = 0.7602, p < 0.001), large provincial and municipal tertiary hospitals (β = 0.2635, p < 0.001), and have beds available on the day (β = 0.1962, p = 0.0028). Out-of-pocket expenses per time (β=-0.0006, p < 0.001) are a negative predictor of patients' inpatient preference. Additionally, Patients were willing to pay ¥1253, ¥434, and ¥323 for higher institutional scale, shorter waiting time, and shorter time from residence-to-hospital, respectively. The findings of subgroup analysis indicated that some demographic characteristics (age, gender, education and total household income) and overall perceived disease severity also influence MCC patients' inpatient preferences. Conclusion This study provides evidence on the inpatient preferences among MCC patients. To better meet patients’ needs, it is recommended to improve the geographical accessibility of medical and health services, strengthen the service capacity of medical personnel in county and community-level medical institutions, streamline the inpatient diagnosis and treatment process, and so on.