What do women want? Valuing women’s preferences and estimating demand for alternative models of maternity care using a discrete choice experiment

• Published in: Health policy (Amsterdam) 2017-11, Vol.121 (11), p.1154-1160
• Main Authors: Fawsitt, Christopher G., Bourke, Jane, Greene, Richard A., McElroy, Brendan, Krucien, Nicolas, Murphy, Rosemary, Lutomski, Jennifer E.
• Format: Article
• Language: English
• Subjects: Adult; Choice Behavior; Consultant-led care; Continuity of Patient Care; Cost analysis; Discrete choice; Discrete choice experiment; Effectiveness; Female; Health administration; Hospitals; Humans; Ireland; Maternal child nursing; Maternal Health Services - statistics & numerical data; Midwifery; Midwifery-led care; Obstetrics; Policy making; Preferences; Pregnancy; Prenatal care; Services; Surveys and Questionnaires; Teaching; Teaching hospitals; Uptake; Welfare; Willingness to pay; Women
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2017.09.013

•This is the first study to model demand for maternity care services.•More women would prefer a hybrid model of consultant- and midwifery-led care.•Pursuing each model of care generates a considerable welfare gain for women.•This research gives women a voice in the reconfiguration of maternity services. In many countries, there has been a considerable shift towards providing a more woman-centred maternity service, which affords greater consumer choice. Maternity service provision in Ireland is set to follow this trend with policymakers committed to improving maternal choice at hospital level. However, women’s preferences for maternity care are unknown, as is the expected demand for new services. In this paper, we used a discrete choice experiment (DCE) to (1) investigate women’s strengths of preference for different features of maternity care; (2) predict market uptake for consultant- and midwifery-led care, and a hybrid model of care called the Domiciliary In and Out of Hospital Care scheme; and (3) calculate the welfare change arising from the provision of these services. Women attending antenatal care across two teaching hospitals in Ireland were invited to participate in the study. Women’s preferred model of care resembled the hybrid model of care, with considerably more women expected to utilise this service than either consultant- or midwifery-led care. The benefit of providing all three services proved considerably greater than the benefit of providing two or fewer services. From a priority setting perspective, pursuing all three models of care would generate a considerable welfare gain, although the cost-effectiveness of such an approach needs to be considered.