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Patients’ preferences in dental care: A discrete-choice experiment and an analysis of willingness-to-pay

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  • Susanne Felgner
  • Cornelia Henschke

Abstract

Introduction: Dental diseases are a major problem worldwide. Costs are a burden on healthcare systems and patients. Missed treatments can have health and financial consequences. Compared to other health services, dental treatments are only covered in parts by statutory health insurance (SHI). Using the example of dental crowns for a cost-intensive treatment, our study aims to investigate whether (1) certain treatment attributes determine patients’ treatment choice, and (2) out-of-pocket payments represent a barrier to access dental care. Methods: We conducted a discrete-choice-experiment by mailing questionnaires to 10,752 people in Germany. In presented scenarios the participants could choose between treatment options (A, B, or none) composed of treatment attribute levels (e.g., color of teeth) for posterior (PT) and anterior teeth (AT). Considering interaction effects, we used a D-efficient fractional factorial design. Choice analysis was performed using different models. Furthermore, we analyzed willingness-to-pay (WTP), preference of choosing no and SHI standard care treatment, and influence of socioeconomic characteristics on individual WTP. Results: Out of n = 762 returned questionnaires (response rate of r = 7.1), n = 380 were included in the analysis. Most of the participants are in age group "50 to 59 years" (n = 103, 27.1%) and female (n = 249, 65.5%). The participants’ benefit allocations varied across treatment attributes. Aesthetics and durability of dental crowns play most important roles in decision-making. WTP regarding natural color teeth is higher than standard SHI out-of-pocket payment. Estimations for AT dominate. For both tooth areas, "no treatment" was a frequent choice (PT: 25.7%, AT: 37.2%). Especially for AT, treatment beyond SHI standard care was often chosen (49.8%, PT: 31.3%). Age, gender, and incentive measures (bonus booklet) influenced WTP per participant. Conclusion: This study provides important insights into patient preferences for dental crown treatment in Germany. For our participants, aesthetic for AT and PT as well as out-of-pocket payments for PT play an important role in decision-making. Overall, they are willing to pay more than the current out-of-pockt payments for what they consider to be better crown treatments. Findings may be valuable for policy makers in developing measures that better match patient preferences.

Suggested Citation

  • Susanne Felgner & Cornelia Henschke, 2023. "Patients’ preferences in dental care: A discrete-choice experiment and an analysis of willingness-to-pay," PLOS ONE, Public Library of Science, vol. 18(2), pages 1-21, February.
    • Handle: RePEc:plo:pone00:0280441
    DOI: 10.1371/journal.pone.0280441
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    References listed on IDEAS

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    1. Marjon van der Pol & Shiell, Alan & Au, Flora & Johnston, David & Tough, Suzanne, 2008. "Convergent validity between a discrete choice experiment and a direct, open-ended method: Comparison of preferred attribute levels and willingness to pay estimates," Social Science & Medicine, Elsevier, vol. 67(12), pages 2043-2050, December.
    2. Emily Lancsar & Jordan Louviere, 2008. "Conducting Discrete Choice Experiments to Inform Healthcare Decision Making," PharmacoEconomics, Springer, vol. 26(8), pages 661-677, August.
    3. Susanne Felgner & Marie Dreger & Cornelia Henschke, 2022. "Reasons for (not) choosing dental treatments—A qualitative study based on patients’ perspective," PLOS ONE, Public Library of Science, vol. 17(5), pages 1-19, May.
    4. Kjaer, Trine & Gyrd-Hansen, Dorte, 2008. "Preference heterogeneity and choice of cardiac rehabilitation program: Results from a discrete choice experiment," Health Policy, Elsevier, vol. 85(1), pages 124-132, January.
    5. Esther W. de Bekker‐Grob & Mandy Ryan & Karen Gerard, 2012. "Discrete choice experiments in health economics: a review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 145-172, February.
    6. Train,Kenneth E., 2009. "Discrete Choice Methods with Simulation," Cambridge Books, Cambridge University Press, number 9780521747387, June.
    7. Lopez-Feldman, Alejandro, 2012. "Introduction to contingent valuation using Stata," MPRA Paper 41018, University Library of Munich, Germany.
    8. Denzil G. Fiebig & Michael P. Keane & Jordan Louviere & Nada Wasi, 2010. "The Generalized Multinomial Logit Model: Accounting for Scale and Coefficient Heterogeneity," Marketing Science, INFORMS, vol. 29(3), pages 393-421, 05-06.
    9. Stephane Hess & John Rose, 2012. "Can scale and coefficient heterogeneity be separated in random coefficients models?," Transportation, Springer, vol. 39(6), pages 1225-1239, November.
    10. Arne Risa Hole, 2007. "Fitting mixed logit models by using maximum simulated likelihood," Stata Journal, StataCorp LLC, vol. 7(3), pages 388-401, September.
    11. Stephanie Stock & Björn Stollenwerk & Gabriele Klever-Deichert & Marcus Redaelli & Guido Büscher & Christian Graf & Klaus Möhlendick & Jan Mai & Andreas Gerber & Markus Lüngen & Karl Lauterbach, 2008. "Preliminary analysis of short term financial implications of a prevention bonus program: First results from the German statutory health insurance," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 53(2), pages 78-86, April.
    12. Mickael Bech & Trine Kjaer & Jørgen Lauridsen, 2011. "Does the number of choice sets matter? Results from a web survey applying a discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 20(3), pages 273-286, March.
    13. Kelvin J. Lancaster, 1966. "A New Approach to Consumer Theory," Journal of Political Economy, University of Chicago Press, vol. 74(2), pages 132-132.
    14. Yuanyuan Gu & Arne Risa Hole & Stephanie Knox, 2013. "Fitting the generalized multinomial logit model in Stata," Stata Journal, StataCorp LLC, vol. 13(2), pages 382-397, June.
    15. David Hensher & John Rose & William Greene, 2005. "The implications on willingness to pay of respondents ignoring specific attributes," Transportation, Springer, vol. 32(3), pages 203-222, May.
    16. Allin, Sara & Farmer, Julie & Quiñonez, Carlos & Peckham, Allie & Marchildon, Gregory & Panteli, Dimitra & Henschke, Cornelia & Fattore, Giovanni & Lamloum, Demetrio & Holden, Alexander C.L. & Rice, T, 2020. "Do health systems cover the mouth? Comparing dental care coverage for older adults in eight jurisdictions," Health Policy, Elsevier, vol. 124(9), pages 998-1007.
    17. Jeff Bennett & Russell Blamey (ed.), 2001. "The Choice Modelling Approach to Environmental Valuation," Books, Edward Elgar Publishing, number 2028, March.
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