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.
Value in Health 11/2010; 13(7). DOI:10.1016/S1098-3015(11)72768-1 · 2.89 Impact Factor
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ABSTRACT: Background Proximal humeral fracture constitutes a medical emergency on most occasions in which the decision to perform either open reduction and internal fixation (ORIF) or hemiarthroplasty is determined by the operating surgeon. Hemiarthroplasty is a more expensive and technically challenging procedure that requires compliance with rigorous and prolonged rehabilitation postsurgically. We assessed whether racial differences exist in utilization of hemiarthroplasty versus ORIF in patients with proximal humeral fracture. Methods Patients with primary diagnosis of closed proximal humeral fracture undergoing either hemiarthroplasty or ORIF were selected from Nationwide Inpatient Sample databases for 1990–2000 (n = 10,306). Results Among white patients with proximal humeral fracture, 35.3% underwent hemiarthroplasty when compared with 17.2% of black and 26.9% of Hispanic patients (PEuropean Journal of Orthopaedic Surgery & Traumatology 12/2011; 21(8). DOI:10.1007/s00590-011-0762-5 · 0.18 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.