Ethnic differences in health preferences: Analysis using willingness-to-pay

Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
The Journal of Rheumatology (Impact Factor: 3.19). 10/2004; 31(9):1811-8.
Source: PubMed


Racial and ethnic differences in health services utilization are well recognized, but the explicit contribution of access to care, physician bias, and patient preferences to these disparities remains unclear. We investigated whether preferences for improvements in health vary among ethnic groups. We chose to assess preferences for osteoarthritis (OA) of the knee because significant differences have been observed in the utilization of total knee arthroplasty among ethnic groups, and because it is an elective procedure, where individual preferences have a major role in decision-making.
A survey using willingness-to-pay (WTP) methodology was conducted to elicit preferences for improvement in severe and mild OA and for 5 non-health items; data were collected from 193 white, African American, and Hispanic individuals over the age of 20 years. Multivariate regression analyses were used to determine whether WTP varied across racial/ethnic groups.
WTP as a percentage of income for each of the 3 scenarios was highest for whites, intermediate for Hispanics, and lowest for African Americans (e.g., 32.9%, 26.4%, and 16.7% for mild OA). Controlling for income, differences in log WTP between African Americans and whites were significant in multivariate regression analyses, whereas values for Hispanics and whites did not differ significantly. Race/ethnic group variables explained a relatively large (21-30%) part of the variation in log WTP.
The findings suggest that ethnic differences in health valuation and preferences contribute to the observed disparities in health services utilization of elective procedures such as total knee arthroplasty.

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    • "Assessing a patient's willingness to pay (WTP) is one of the most accepted methods to evaluate the acceptability of new treatment modality for the clinician. It has been used to successfully measure patient's perception in not only in dentistry,[9–11] but in fields such as orthopedics,[12] cardiology[1213] and health care service preferences.[14] Bidding is the oldest and most accepted tool to assess WTP of a patient and provides both clinicians and third party payment providers with a realistic estimate of how much a patient can spend on a new treatment modality.[15] "
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    ABSTRACT: One of the factors that dissuade patients needing tooth replacement from choosing dental implants is the prohibitive cost. Willingness to pay (WTP) is a useful tool to determine the ideal cost of an expensive procedure. The aim of this study was to study the factors that influence the willingness to pay (WTP) among patients attending a private clinic and compare them to those attending a government setup. A total of 100 patients (38 male, 62 female) who had one or more missing teeth were presented with different cost-benefit scenarios and then asked if they were willing to pay the median cost of a single implant in Riyadh city. The mean WTP price was compared using the one way-ANOVA, factors which could possibly influence patients' WTP were grouped together in a Binomial logistic regression model. Of the 100 individuals surveyed 67% said they would be willing to pay the median price for the placement of an implant. A comparison of socio-demographic factors showed that significant differences were found between gender, income groups and setting of the clinic in the mean WTP price of the patients (P < 0.05). We also found that there was a significant difference in the mean WTP price between groups with regard to the area of the missing tooth, the patients' perception of their oral health and the their desire to want an implant (P < 0.05). The majority of the patients surveyed were willing to pay the median price for an implant. Willingness to pay (WTP) is a multifactorial variable which is significantly influenced by the income of the patient, the setting of the clinic and the gender; the most significant factor being the acceptability of the implant to the patient.
    Dental research journal 11/2012; 9(6):719-24.
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    • "There is evidence that patients' preferences for surgery vary in association with gender [10,23-25], ethnicity [26-30], and age [8,13,23,31,32]. The decision-making process is also influenced by how patients calculate the trade off between perceived costs and benefits [33]; their views about likely outcomes of surgery [28,34]; and their willingness to undergo surgery [32,35,36]. "
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    ABSTRACT: Total joint replacement (TJR) of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations. The study used a qualitative research design comprising semi-structured interviews and observations. Participants were recruited from three hospital sites and provided their time free of charge. Seven clinicians involved in decision-making about TJR were approached to take part in the study, and six agreed to do so. Seventy-seven patients due to see these clinicians about TJR were approached to take part and 26 agreed to do so. The patients' outpatient appointments ('consultations') were observed and audio-recorded. Subsequent interviews with patients and clinicians examined decisions that were made at the appointments. Data were analysed using thematic analysis. Clinical and lifestyle factors were central components of the decision-making process. In addition, the roles that patients assigned to clinicians were key, as were communication styles. Patients saw clinicians as occupying expert roles and they deferred to clinicians' expertise. There was evidence that patients modified their behaviour within consultations to complement that of clinicians. Clinicians acknowledged the complexity of decision-making and provided descriptions of their own decision-making and communication styles. Patients and clinicians were aware of the use of clinical and lifestyle factors in decision-making and agreed in their description of clinicians' styles. Decisions were usually reached during consultations, but patients and clinicians sometimes said that treatment decisions had been made beforehand. Some patients expressed surprise about the decisions made in their consultations, but this did not necessarily imply dissatisfaction. The way in which roles and communication are played out in decision-making for TJR may affect the opportunity for shared decisions. This may contribute to variation in the provision of TJR. Making the importance of these factors explicit and highlighting the existence of patients' 'surprise' about consultation outcomes could empower patients within the decision-making process and enhance communication in orthopaedic consultations.
    BMC Musculoskeletal Disorders 09/2010; 11(1):213. DOI:10.1186/1471-2474-11-213 · 1.72 Impact Factor
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    ABSTRACT: Incorporating patients' preferences into healthcare decisions has been identified as one mechanism for reducing health disparities. Some research suggests that providers need to tailor medical recom-mendations to the preferences of their patients. Yet there are few tools to facilitate clarification of preferences for health services. This paper reports the process of testing an innovative preference elicitation tech-nique—conjoint analysis—among minorities and low literacy patients using the example of colorectal cancer (CRC) screening. CRC screening exemplifies preference-sensitive healthcare as there exist several screen-ing options. However, screening rates among minorities are low. Better methods for preference assessment could improve patient-provider communication and increase patient adherence. This study used quali-tative methods and piloting to refine and finalize a conjoint analysis preference assessment instrument. We conclude that conjoint analysis is a viable preference assessment methodology for use in vulnerable populations with appropriate tailoring of materials. Future work will evaluate integrating this method into clinical decision tools.
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