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Patient Preferences for Features of Health Care Delivery Systems: A Discrete Choice Experiment
Author(s) -
Mühlbacher Axel C.,
Bethge Susanne,
Reed Shelby D.,
Schulman Kevin A.
Publication year - 2016
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12345
Subject(s) - context (archaeology) , health care , medicine , data collection , statistics , paleontology , economics , biology , mathematics , economic growth
Objective To estimate the relative importance of organizational‐, procedural‐, and interpersonal‐level features of health care delivery systems from the patient perspective. Data Sources/Study Setting We designed four discrete choice experiments ( DCE s) to measure patient preferences for 21 health system attributes. Participants were recruited through the online patient portal of a large health system. We analyzed the DCE data using random effects logit models. Data Collection/Extraction Methods DCE s were performed in which respondents were provided with descriptions of alternative scenarios and asked to indicate which scenario they prefer. Respondents were randomly assigned to one of the three possible health scenarios (current health, new lung cancer diagnosis, or diabetes) and asked to complete 15 choice tasks. Each choice task included an annual out‐of‐pocket cost attribute. Principal Findings A total of 3,900 respondents completed the survey. The out‐of‐pocket cost attribute was considered the most important across the four different DCE s. Following the cost attribute, trust and respect, multidisciplinary care, and shared decision making were judged as most important. The relative importance of out‐of‐pocket cost was consistently lower in the hypothetical context of a new lung cancer diagnosis compared with diabetes or the patient's current health. Conclusions This study demonstrates the complexity of patient decision making processes regarding features of health care delivery systems. Our findings suggest the importance of these features may change as a function of an individual's medical conditions.