Patient Preferences for Features of Health Care Delivery Systems: A Discrete Choice Experiment

• Published in: Health services research 2016-04, Vol.51 (2), p.704-727
• Main Authors: Mühlbacher, Axel C., Bethge, Susanne, Reed, Shelby D., Schulman, Kevin A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Attributes; Cancer; Care delivery; Choice Behavior; Data acquisition; Data collection; Data entry; Data processing; Decision Making; delivery of health care; Delivery of Health Care - economics; Delivery of Health Care - organization & administration; Delivery systems; Diabetes; Diabetes mellitus; Diabetes Mellitus - economics; Diabetes Mellitus - therapy; Diagnosis; Discrete choice; discrete choice models; Extraction; Female; Financing, Personal - statistics & numerical data; Government regulation; Group decision making; Health care; Health care delivery; Health insurance; Health Status; Humans; Improving Patient‐Centered Care; Interdisciplinary aspects; Laws, regulations and rules; Logit models; Lung cancer; Lung Neoplasms - economics; Lung Neoplasms - therapy; Male; Medical conditions; Medical diagnosis; Medicare; Middle Aged; Out of pocket costs; Patient Care Team; Patient Participation; Patient preference; Patient Preference - statistics & numerical data; Patients; Personal expenditure; Random effects; Social services delivery; Studies; Treatment preferences; Trust; Web portals; Young Adult
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12345

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 (DCEs) 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 DCEs 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 DCEs. 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.