Optimisation of services to prevent dental caries for school-aged children in China: a discrete choice experiment

Abstract

Objectives: The objective of this study is to analyse the preferences of guardians of school-aged children for children's caries prevention services (CPS) and their willingness to pay (WTP) for different levels of attributes.

Design: Four key attributes were identified through a literature review and expert consultations: preventive service time, preventive effectiveness, distance (driving time to service institution) and service cost (out-of-pocket for CPS). A D-efficient design was used to create a discrete choice experiment questionnaire, and data were collected via face-to-face interviews.

Setting: Data collection was conducted between July 2021 and January 2022 in Anhui, China.

Participants: Guardians (785) of children aged 3-12 years participated.

Main outcome measures: A mixed-logit model was used to estimate preferences and WTP for different attribute levels, and the preference heterogeneity was assessed using a latent class logit model.

Results: Preventive effectiveness was the most important attribute, followed by service cost, preventive service time and distance. Guardians preferred CPS with over 90% preventive effectiveness, a distance of 10-25 min, services offered during vacations and lower service cost. Guardians were willing to pay 409 Chinese yuan (CNY) for higher effectiveness, 84 CNY for shorter distances and 87 CNY for services offered during vacation. Guardians with a college education or higher and females prioritise preventive effectiveness, while guardians who had children with a caries history and who had children with better oral health status preferred CPS during vacation.

Conclusions: All four attributes influenced guardians' preferences for CPS, with preventive effectiveness being the most important. Guardians were willing to pay extra money for better CPS, and preferences varied according to individual characteristics. These findings provide a reference for policy-makers to provide personalised, demand-based CPS.

Keywords: China; Community child health; HEALTH ECONOMICS; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; Health Equity; Health Services.