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Community Hypertension Patients' Preferences for Family Doctor Service Packages in China: A Discrete Choice
Yubo He1,2, Yihong Cheng3, Zixuan Zhang4,5
1School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, People's Republic of China.
Purpose:
Despite high coverage of China's Family Doctor Contract Services (FDCS), substantive utilization among hypertensive populations remains suboptimal. By decomposing service packages into granular clinical components, this study addresses the limitations of prior research focused on generic primary care attributes. We aim to quantify patient preferences and identify heterogeneity to align service delivery with specialized management needs, thereby facilitating the transition from nominal enrollment to substantive engagement.
Methods:
A Discrete Choice Experiment (DCE) was conducted to community hypertension patients in Nanjing, China. Five key attributes were identified through literature review, qualitative interviews, and expert consultation. A Mixed Logit Model (MLM) and Latent Class Model (LCM) were employed to estimate attribute importance, willingness to pay (WTP), and preference heterogeneity.
Results:
Analysis of 638 responses, with 596 participants passing the internal consistency check. The Mixed Logit Model demonstrated that all five attributes exerted a statistically significant influence on patient choices. In terms of relative importance, medication type was the primary driver, followed by the scope of services, payment method, appointment scheduling, and the annual contract fee. WTP estimates indicated positive valuations for original-brand medications, integrated clinical service bundles, and multi-source payment structures. Furthermore, the Latent Class Model identified two distinct subgroups reflecting preference heterogeneity within the sample.
Conclusion:
Therapeutic certainty significantly outweighs economic considerations for community hypertension patients, with the pronounced preference for original-brand medications serving as a critical proxy for clinical safety. Policy should encompass state-led support for original-drug development while simultaneously enhancing institutional trust in generic alternatives through transparent quality evidence. Transitioning toward stratified, patient-centered management is essential to address preference heterogeneity and improve the substantive effectiveness of the family doctor system in China.
