title: Think twice before you book? Modelling the choice of public vs private dentist in a choice experiment.
abstract: This study concerns the choice of primary dental service provider by consumers. If the health service delivery system allows individuals to choose between public-care providers or if complementary private services are available, it is typically assumed that utilisation is a three-stage decision process. The patient first makes a decision to seek care, and then chooses the service provider. The final stage, involving decisions over the amount and form of treatment, is not considered here. The paper reports a discrete choice experiment (DCE) designed to evaluate attributes affecting individuals' choice of dental-care provider. The feasibility of the DCE approach in modelling consumers' choice in the context of non-acute need for dental care is assessed. The aim is to test whether a separate two-stage logit, a multinomial logit, or a nested logit best fits the choice process of consumers. A nested logit model of indirect utility functions is estimated and inclusive value (IV) constraints are tested for modelling implications. The results show that non-trading behaviour has an impact on the choice of appropriate modelling technique, but is to some extent dependent on the choice of scenarios offered. It is concluded that for traders multinomial logit is appropriate, whereas for non-traders and on average the nested logit is the method supported by the analyses. The consistent finding in all subgroup analyses is that the traditional two-stage decision process is found to be implausible in the context of consumer's choice of dental-care provider.
authors.affiliation: THL, National Institute for Health and Welfare, Helsinki, Finland. urpo.kiiskinen@lilly.com
authors.forename: Urpo
authors.initials: U
authors.lastname: Kiiskinen
authors.forename: Anna Liisa
authors.initials: AL
authors.lastname: Suominen-Taipale
authors.forename: John
authors.initials: J
authors.lastname: Cairns
mesh_terms: D002755:Choice Behavior; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D003815:Dentists; D005387:Finland; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D009313:National Health Programs; D017149:Private Sector; D017150:Public Sector; D011787:Quality of Health Care; D014850:Waiting Lists