scholarly journals Varying Opinions on Who Deserves Collectively Financed Health Care Services: A Discrete Choice Experiment on Allocation Preferences of the General Public

2018 ◽  
Vol 55 ◽  
pp. 004695801775198
Author(s):  
Maartje J. van der Aa ◽  
Aggie T. G. Paulus ◽  
Mickaël J. C. Hiligsmann ◽  
Johannes A. M. Maarse ◽  
Silvia M. A. A. Evers
Keyword(s):  
Health Care ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
General Public ◽  
Choice Experiment ◽  
Access To Health Care ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Financial Capacity ◽  
Medical Needs

In Europe, health insurance arrangements are under reform. These arrangements redistribute collectively financed resources to ensure access to health care for all. Allocation of health services is historically based on medical needs, but use of other criteria, such as lifestyle, is debated upon. Does the general public also have preferences for conditional allocation? This depends on their opinions regarding deservingness. The aim of this study was to gain insight in those opinions, specifically by examining the perceived weight of different criteria in allocation decisions. Based on literature and expert interviews, we included 5 criteria in a discrete choice experiment: need, financial capacity, lifestyle, cooperation with treatment, and package/premium choice. A representative sample of the Dutch population was invited to participate (n = 10 760). A total of 774 people accessed the questionnaire (7.2%), of whom 375 completed it (48.4%). Medical need was overall the most important criterion in determining deservingness (range β = 1.60). Perceived deservingness decreased if claimants had higher financial capacity (1.26) and unhealthier lifestyle (1.04), if their cooperation was less optimal (1.05), or if they had opted for less insurance coverage (0.56). However, preferences vary among respondents, in relation to demographic and ideological factors.

scholarly journals A Discrete-Choice Experiment to capture public preferences on the benefits of home-visiting programme for teenage mothers

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 677
Author(s):  
Eugena Stamuli ◽  
Gerry Richardson ◽  
Michael Robling ◽  
Michelle Edwards ◽  
David Torgerson ◽  
...  
Keyword(s):  
Child Development ◽  
Life Course ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
General Public ◽  
Choice Experiment ◽  
Social Care ◽  
Building Blocks ◽  
Public Preferences ◽  
Health And Social Care

Background: Complex health and social care interventions impact on a multitude of outcomes. One such intervention is the Family Nurse Partnership (FNP) programme, which was introduced to support young, first-time mothers. Our study quantified the relative values that the general public place on the outcomes of FNP, as they were identified and measured in the relevant randomized trial, Building Blocks trial (BBs). Methods: A discrete choice experiment (DCE) was employed. Respondents chose between two scenarios describing hypothetical sets of trial outcomes. BBs compared FNP care for teenagers expecting their first child with standard NHS care. 14 attributes covered three areas: pregnancy and birth, child development and maternal life course. Due to large number of attributes, a “blocked attributes” approach was adopted: the attributes were split across four designs which contained two common attributes. Data were analysed separately for each design as well as pooled across four designs. Random effects probit model was employed for the analysis. Results: Over 1000 participants completed four designs. The analyses on the separate designs and those on pooled data yielded broadly similar results. Respondents valued higher the outcomes related to child development and their needs, followed by the outcomes related to maternal life course. Preferences varied by the age of the respondents but not by their guardianship/parentship status.  Conclusions: Individual preferences were consistent with a priori expectations and were intuitive.  The DCE results can be used to incorporate the general public preferences into the decision making process for which public health and social care policies should be adopted.

scholarly journals Designing a brief behaviour change intervention to reduce sexually transmitted infections: a discrete choice experiment

2018 ◽  
Vol 29 (9) ◽  
pp. 851-860 ◽  
Author(s):  
Alec Miners ◽  
Carrie Llewellyn ◽  
Carina King ◽  
Alex Pollard ◽  
Anupama Roy ◽  
...  
Keyword(s):  
Health Care ◽  
Sexually Transmitted Infections ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Important Determinant ◽  
Behavioural Change ◽  
Behaviour Change Intervention ◽  
Sexually Transmitted ◽  
Sex With Men

To understand whether people attending sexual health (SH) clinics are willing to participate in a brief behavioural change intervention (BBCI) to reduce the likelihood of future sexually transmitted infections (STIs) and to understand their preferences for different service designs, we conducted a discrete choice experiment (DCE) with young heterosexual adults (aged 16–25 years), and men who have sex with men (MSM) aged 16 or above, attending SH clinics in England. Data from 368 participants showed that people particularly valued BBCIs that involved talking (OR 1.45; 95%CI 1.35, 1.57 compared with an ‘email or text’-based BBCIs), preferably with a health care professional rather than a peer. Findings also showed that 26% of respondents preferred ‘email/texts’ to all other options; the remaining 14% preferred not to participate in any of the offered BBCIs. These results suggest that most people attending SH clinics in England are likely to participate in a BBCI if offered, but the type/format of the BBCI is likely to be the single important determinant of uptake rather than characteristics such as the length and the number of sessions. Moreover, participants generally favoured ‘talking’-based options rather than digital alternatives, which are likely to require the most resources to implement.

scholarly journals Patients’ preferences for health insurance coverage of new technologies for treating chronic diseases in China: a discrete choice experiment

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038051
Author(s):  
Jinsong Geng ◽  
Xiaowei Chen ◽  
Haini Bao ◽  
Danmin Qian ◽  
Yuting Shao ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Diseases ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
New Technologies ◽  
Insurance Coverage ◽  
Medical Insurance ◽  
Basic Medical Insurance ◽  
Basic Medical

ObjectivesOur study aimed to inform insurance decision-making in China by investigating patients’ preferences for insurance coverage of new technologies for treating chronic diseases.DesignWe identified six attributes of new medical technologies for treating chronic diseases and used Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). After conducting the DCE, we analysed the data by mixed logit regression to examine patient-reported preferences for each attribute.SettingThe DCE was conducted with patients in six tertiary hospitals from four cities in Jiangsu province.ParticipantsPatients aged 18 years or older with a history of diabetes or hypertension and taking medications regularly for more than 1 year were recruited (n=408).ResultsThe technology attributes regarding expected gains in health outcomes from the treatment, high likelihood of effective treatment and low incidence of serious adverse events were significant, positive predictors of choice by the study patients (p<0.01). The out-of-pocket cost was a significant, negative attribute for the entire study sample (β = −0.258, p<0.01) and for the patients with Urban-Rural Residents Basic Medical Insurance (URRBMI) (β = −0.511, p<0.01), but not for all the patients with Urban Employees Basic Medical Insurance (UEBMI) (β = −0.071, p>0.05). The severity of target disease was valued by patients with lower EQ-5D-5L index value as well as URRBMI enrollees.ConclusionsPatients highly valued the health benefits and risks of new technologies, which were closely linked to their feelings of disease and perceptions of health-related quality of life. However, there existed heterogeneity in preferences between URRBMI and UEBMI patients. Further efforts should be made to reduce the gap between insurance schemes and make safe and cost-effective new technologies as a priority for health insurance reimbursement.

scholarly journals Self-Monitoring App Preferences for Sun Protection: Discrete Choice Experiment Survey Analysis (Preprint)

2020 ◽  
Author(s):  
Vasileios Nittas ◽  
Margot Mütsch ◽  
Julia Braun ◽  
Milo Alan Puhan
Keyword(s):  
Health Care ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Sun Protection ◽  
Perceived Usefulness ◽  
Monitoring Method ◽  
Self Monitoring ◽  
Health Apps ◽  
The Way

BACKGROUND The availability and use of health apps continues to increase, revolutionizing the way mobile health interventions are delivered. Apps are increasingly used to prevent disease, improve well-being, and promote healthy behavior. On a similar rise is the incidence of skin cancers. Much of the underlying risk can be prevented through behavior change and adequate sun protection. Self-monitoring apps have the potential to facilitate prevention by measuring risk (eg, sun intensity) and encouraging protective behavior (eg, seeking shade). OBJECTIVE Our aim was to assess health care consumer preferences for sun protection with a self-monitoring app that tracks the duration and intensity of sun exposure and provides feedback on when and how to protect the skin. METHODS We conducted an unlabeled discrete choice experiment with 8 unique choice tasks, in which participants chose among 2 app alternatives, consisting of 5 preidentified 2-level attributes (self-monitoring method, privacy control, data sharing with health care provides, reminder customizability, and costs) that were the result of a multistep and multistakeholder qualitative approach. Participant preferences, and thus, the relative importance of attributes and their levels were estimated using conditional logit modeling. Analyses consisted of 200 usable surveys, yielding 3196 observations. RESULTS Our respondents strongly preferred automatic over manually operated self-monitoring (odds ratio [OR] 2.37, 95% CI 2.06-2.72) and no cost over a single payment of 3 Swiss francs (OR 1.72, 95% CI 1.49-1.99). They also preferred having over not having the option of sharing their data with a health care provider of their choice (OR 1.66, 95% CI 1.40-1.97), repeated over single user consents, whenever app data are shared with commercial thirds (OR 1.57, 95% CI 1.31-1.88), and customizable over noncustomizable reminders (OR 1.30, 95% CI 1.09-1.54). While most participants favored thorough privacy infrastructures, the attribute of privacy control was a relatively weak driver of app choice. The attribute of self-monitoring method significantly interacted with gender and perceived personal usefulness of health apps, suggesting that female gender and lower perceived usefulness are associated with relatively weaker preferences for automatic self-monitoring. CONCLUSIONS Based on the preferences of our respondents, we found that the utility of a self-monitoring sun protection app can be increased if the app is simple and adjustable; requires minimal effort, time, or expense; and has an interoperable design and thorough privacy infrastructure. Similar features might be desirable for preventive health apps in other areas, paving the way for future discrete choice experiments. Nonetheless, to fully understand these preference dynamics, further qualitative or mixed method research on mobile self-monitoring-based sun protection and broader preventive mobile self-monitoring is required. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16087

scholarly journals Physical Injuries and Burns among Refugees in Lebanon: Implications for Programs and Policies

2021 ◽  
Author(s):  
Samar Al-Hajj ◽  
Moustafa Moustafa ◽  
Majed El Hechi ◽  
Mohamad A. Chahrour ◽  
Ali A. Nasrallah ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Cooking Methods ◽  
P Value ◽  
Special Focus ◽  
Seek Health Care ◽  
Physical Injuries

Background: Refugees are prone to injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study systematically quantified the prevalence of physical injuries and burns among the refugee community in Western Lebanon and examined injury characteristics, risk factors and outcomes. Method: We conducted a cluster-based population survey across 21 camps in the Bekaa region of Lebanon from February to April 2019. A modified version of the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool v 3.0 was administered to the head of the refugee household and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables. Results: 750 heads of household were surveyed. 112 (14.9%) household sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Most injuries occurred inside the tent (29.9%). A burn was sustained by at least one household member in 136 (18.1%) households. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers have the inability to lockout children while cooking (25.6% vs 14.9%, p-value=0.001). Similarly, households with unemployed head significantly had more reported burns (19.7% vs 13.3%, p-value=0.05). Nearly 16.1% of injured refugees were unable to seek health care due to lack of health insurance coverage and financial liability. Conclusion: Refugees suffer injuries and burns with substantial human and economic repercussions on individuals, their families and the host healthcare system. Resources should be allocated to designing safe camps and implementing educational and awareness programs with special focus on heating and cooking methods.

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