title: Ethnic differences in health preferences: analysis using willingness-to-pay.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. byrnem@pitt.edu
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Byrne
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: O'Malley
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000208:ethnology* / Q000601:surgery; D017060:Patient Satisfaction / Q000191:economics* / Q000208:ethnology* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012923:Social Class; D044465:White People / Q000706:statistics & numerical data