Ethnic differences in health preferences: Analysis using willingness-to-pay
ABSTRACT 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.
- SourceAvailable from: clinexprheumatol.org[Show abstract] [Hide abstract]
ABSTRACT: Although total joint replacement is an effective treatment option for end-stage lower extremity osteoarthritis, racial disparities in joint replacement utilization have been well documented. These disparities may be due in part to patient-level factors such as willingness to consider joint replacement and worse expectations of joint replacement outcomes. In addition, African-Americans may have worse outcomes after total joint replacement and are more likely to have surgery performed by surgeons with lower volumes or in hospitals with lower volumes. All of these issues may be considered concerns with the quality of care delivered to African-Americans with osteoarthritis.Clinical and experimental rheumatology 25(6 Suppl 47):44-9. · 2.97 Impact Factor
- [Show abstract] [Hide abstract]
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.
- Arthritis & Rheumatology 12/2005; 53(6):805-7. DOI:10.1002/art.21600 · 7.87 Impact Factor