Advertisement

Women’s Preferences for Birthing Hospital in Denmark: A Discrete Choice Experiment

  • Nasrin Tayyari Dehbarez
  • Morten Raun Mørkbak
  • Dorte Gyrd-Hansen
  • Niels Uldbjerg
  • Rikke Søgaard
Original Research Article

Abstract

Background

Free choice of hospital has been introduced in many healthcare systems to accommodate patient preferences and incentivize hospitals to compete; however, little is known about what patients actually prefer.

Objectives

This study assessed women’s preferences for birthing hospital in Denmark by quantifying the utility and trade-offs of hospital attributes.

Methods

We conducted a discrete-choice experiment survey with 12 hypothetical scenarios in which women had to choose between three hospitals characterized by five attributes: continuity of midwifery care, availability of a neonatal intensive care unit (NICU), hospital services offered, level of specialization to handle rare events, and travel time. A random parameter logit model was used to estimate the utility and marginal willingness to travel (WTT) for improvements in other hospital attributes.

Results

A total of 517 women completed the survey. Significant preferences were expressed for all attributes (p < 0.01), with the availability of a NICU being the most important driver of women’s preferences; women were willing to travel 30 more minutes (95% confidence interval 28–32) to reach a hospital with a highly specialized NICU. The subgroup analyses revealed differences in WTT, with substantial heterogeneity due to prior experience with giving birth and regarding risk attitude and health literacy.

Conclusion

A high specialization level was the most influential factor for women without previous birth experience and for risk-averse individuals but not for women with a high health literacy score. Hence, more information about the woman’s risk profile and services required could play a role in affecting hospital choice.

Notes

Acknowledgements

The authors thank the volunteers for participating in individual and focus group interviews in the design phase of the study.

Author Contributions

NTD contributed to the study design, data analysis, interpretation of results, drafting the manuscript, and reporting. MRM, DG-H, and RS contributed to the study design, data analysis, interpretation of results, writing, and reporting. NU contributed to study design to ensure the applicability and relevance of the survey instrument, writing and reporting. All authors approved the manuscript.

Compliance with Ethical Standards

Ethical approval

The Central Denmark Region data approval committee approved the study (Journal number 1-16-02-40-15).

Funding

This study was funded by the Central Denmark Region Health Research Fund, Aarhus University and the Health Foundation (Grant number 15-B-0122).

Conflicts of interest

N. Tayyari Dehbarez, M. Raun Mørkbak, D. Gyrd-Hansen, N. Uldbjerg, and R. Søgaard have no conflicts of interest.

Supplementary material

40271_2018_313_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)
40271_2018_313_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 18 kb)
40271_2018_313_MOESM3_ESM.docx (75 kb)
Supplementary material 3 (DOCX 74 kb)

References

  1. 1.
    Vrangbaek K, Robertson R, Winblad U, Van de Bovenkamp H, Dixon A. Choice policies in Northern European health systems. Health Econ Policy Law. 2012;7:47–71.CrossRefPubMedGoogle Scholar
  2. 2.
    Vrangbaek K, Østergren K, Birk HO, Winblad U. Patient reactions to hospital choice in Norway, Denmark, and Sweden. Health Econ Policy Law. 2007;2:125–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Vrangbæk K. Patient empowerment and the introduction of hospital choice in Denmark and Norway. Health Econ Policy Law. 2006;1:371–94.CrossRefPubMedGoogle Scholar
  4. 4.
    Gaynor BM, Propper C, Seiler S. Free to choose? Reform, choice, and consideration sets in the English National Health Service. Am Econ Rev. 2016;106:3521–57.CrossRefPubMedGoogle Scholar
  5. 5.
    Moscelli G, Siciliani L, Gutacker N, Cookson R., Socioeconomic inequality of access to healthcare: Does patients’ choice explain the gradient? CHE Res.Pap. 2015;112.Google Scholar
  6. 6.
    Moscelli G, Siciliani L, Gutacker N, Gravelle H. Regional science and urban economics location, quality and choice of hospital: evidence from England 2002–2013. Reg Sci Urban Econ. 2016;60:112–24.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Dawson D, Jacobs R, Martin S, Smith P. Evaluation of the London patient choice project: system wide impacts final report. September, 2004.Google Scholar
  8. 8.
    Jung K, Feldman R, Scanlon D. Where would you go for your next hospitalization? J Health Econ. 2011;30:832–41.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Brown P, Panattoni L, Cameron L, Knox S, Ashton T, Tenbensel T, Windsor J. Hospital sector choice and support for public hospital care in New Zealand: results from a labeled discrete choice survey. J Health Econ. 2015;43:118–27.CrossRefPubMedGoogle Scholar
  10. 10.
    Gooberman-Hill R. Qualitative approaches to understanding patient preferences. Patient. 2012;5:215–23.PubMedGoogle Scholar
  11. 11.
    Burge P, Devlin N, Appleby J, Rohr C, Grant J. Do patients always prefer quicker treatment? A discrete choice analysis of patients’ stated preferences in the London patient choice project. Appl Health Econ Health Policy. 2005;3:183–94.CrossRefGoogle Scholar
  12. 12.
    Murray-Davis B, McDonald H, Rietsma A, Coubrough M, Hutton E. Deciding on home or hospital birth: results of the Ontario choice of birthplace survey. Midwifery. 2014;30(7):869–76.  https://doi.org/10.1016/j.midw.2014.01.008.CrossRefPubMedGoogle Scholar
  13. 13.
    Regan M, McElroy K. Women’s perceptions of childbirth risk and place of birth. J Clin Ethics. 2013;24(3):239–52.PubMedGoogle Scholar
  14. 14.
    Pavlova M, Hendrix M, Nouwens E, Nijhuis J, Van Merode G. The choice of obstetric care by low-risk pregnant women in the Netherlands: implications for policy and management. Health Policy (New York). 2009;93:27–34.CrossRefGoogle Scholar
  15. 15.
    Haken TVH, Pavlova M, Hendrix M, Nieuwenhuijze M, De Vries R, Nijhuis J. Eliciting preferences for key attributes of intrapartum care in The Netherlands. Birth. 2014;41(2):185–94.CrossRefGoogle Scholar
  16. 16.
    Hundley V, Ryan M, Graham W. Assessing women’s preferences for intrapartum care. Birth Berkeley Calif. 2001;28:254–63.CrossRefGoogle Scholar
  17. 17.
    Fawsitt CG, Bourke J, Greene RA, et al. What do women want? Valuing women’s preferences and estimating demand for alternative models of maternity care using a discrete choice experiment. Health Policy. 2017;121(11):1154–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Dehbarez NT, Lou S, Uldbjerg N, Møller A, Gryd-Hansen D, Søgaard R. Pregnant women’s choice of birthing hospital: a qualitative study on individuals’ preferences. J Women Birth.  https://doi.org/10.1016/j.wombi.2017.11.006.
  19. 19.
    Bekker-Grob EW, Donkers B, Jonker MF, Stolk EA. Sample size requirements for discrete-choice experiments in healthcare: a practical guide. Patient Patient-Centered Outcomes Res. 2015;8:373–84.CrossRefGoogle Scholar
  20. 20.
    ChoiceMetrics. Ngene 1.1.2 User manual & reference guide. 2014. http://www.choice-metrics.com. Accessed 22 Mar 2017.
  21. 21.
    Bierlaire M. BisonBiogeme 2.4: estimating a first model. 2015. Report TRANSPORT-OR 150720.Google Scholar
  22. 22.
    Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health. 2013;13:1.CrossRefGoogle Scholar
  23. 23.
    Galizzi MM, R. Miniaci R, Miniaci R. Temporal stability, cross-validity, and external validity of risk preferences measures: experimental evidence from a UK representative sample. SSRN Electron J. 2016. Working paper.Google Scholar
  24. 24.
    Schwartz B, Ward A, Monterosso J, Lyubomirsky S, White K, Lehman DR. Maximizing versus satisficing: happiness is a matter of choice. J Pers Soc Psychol. 2002;83:1178–97.CrossRefPubMedGoogle Scholar
  25. 25.
    Train K. Discrete choice methods with simulation. Cambridge: Cambridge University Press; 2003.CrossRefGoogle Scholar
  26. 26.
    Poulos C, Kinter E, John JY, Posner J, Reder AT. Patient preferences for injectable treatments for multiple sclerosis in the United States: a discrete-choice experiment. Patient Patient-Centered Outcomes Res. 2016;9:171–80.CrossRefGoogle Scholar
  27. 27.
    Chiou L, Walker JL. Masking identification of discrete choice models under simulation methods. J Econ. 2007;141:683–703.CrossRefGoogle Scholar
  28. 28.
    C.J. Bliemer M, M. Rose J, Confidence intervals of willingness-to-pay for random coefficient logit models. Working paper. The University of Sydney. 2013.Google Scholar
  29. 29.
    Hensher DA, Rose JM, Greene WH. Applied choice analysis. Cambridge: Cambridge University Press; 2015.  https://doi.org/10.1017/CBO9781316136232 CrossRefGoogle Scholar
  30. 30.
    van Haaren-Ten Haken T, Hendrix M, Nieuwenhuijze M, Budé L, de Vries R, Nijhuis J. Preferred place of birth: characteristics and motives of low-risk nulliparous women in the Netherlands. Midwifery. 2012;28:609–18.CrossRefGoogle Scholar
  31. 31.
    Chorus CG, Rose JM, Hensher DA. Regret minimization or utility maximization: it depends on the attribute. Environ Plan B Plan Des. 2013;40(1):154–69.  https://doi.org/10.1068/b38092.CrossRefGoogle Scholar
  32. 32.
    Chorus CG, Arentze TA, Timmermans HJP. A Random Regret-Minimization model of travel choice. Transp Res Part B Methodol. 2008;42(1):1–18.  https://doi.org/10.1016/j.trb.2007.05.004.CrossRefGoogle Scholar
  33. 33.
    Brewer NT, DeFrank JT, Gilkay MB. Anticipated regret and health behaviour: a meta-analysis. Health Psychol. 2016;35(11):1264–75.  https://doi.org/10.1037/hea0000294.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Lancsar E, Louviere J. Deleting ‘irrational’ responses from discrete choice experiments: a case of investigating or imposing preferences? Health Econ. 2006;15:797–811.CrossRefPubMedGoogle Scholar
  35. 35.
    Veldwijk J, Lambooij MS, De Bekker-Grob EW, Smit HA, De Wit GA. The effect of including an opt-out option in discrete choice experiments. PLoS One. 2014;9:e111805.  https://doi.org/10.1371/journal.pone.0111805.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Mark TL, Swait J. Using stated preference modeling to forecast the effect of medication attributes on prescriptions of alcoholism medications. Value Health. 2003;6:474–82.CrossRefPubMedGoogle Scholar
  37. 37.
    Ryan M, Watson V. Comparing welfare estimates from payment card contingent valuation and discrete choice experiments. Health Econ. 2009;18:389–401.  https://doi.org/10.1002/hec.1364.CrossRefPubMedGoogle Scholar
  38. 38.
    Salampessy BH, Veldwijk J, Schuit AJ, De Wit GA, Lambooij MS. The predictive value of discrete choice experiments in public health: an exploratory application. Patient-Centered Outcomes Res. 2015;8:521–9.CrossRefGoogle Scholar
  39. 39.
    Yang JC, Johnson FR, Kilambi V, Mohamed AF. Sample size and utility-difference precision in discrete-choice experiments: a meta-simulation approach. J Choice Model. 2015;16(C):50–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nasrin Tayyari Dehbarez
    • 1
    • 2
  • Morten Raun Mørkbak
    • 3
  • Dorte Gyrd-Hansen
    • 4
  • Niels Uldbjerg
    • 5
  • Rikke Søgaard
    • 2
    • 6
  1. 1.DEFACTUMAarhus NDenmark
  2. 2.Department of Public HealthAarhus UniversityAarhusDenmark
  3. 3.IncentiveHolteDenmark
  4. 4.Danish Centre for Health Economics (DaCHE)University of Southern DenmarkOdense MDenmark
  5. 5.Department of Obstetrics and GynecologyAarhus University HospitalAarhus NDenmark
  6. 6.Department of Clinical MedicineAarhus UniversityAarhus NDenmark

Personalised recommendations