Citizen preferences surrounding desirable health system characteristics should be considered when undertaking health system reform. The objective of this study was to pilot test a discrete-choice instrument designed to elicit preference weights surrounding health system attributes.
A discrete-choice experiment was designed and administered to two convenience samples (n=50 each) recruited from the UK and Australia. The impact of eight health system attributes representing level of health, equity, responsiveness and healthcare financing on the choice between hypothetical health systems was analysed utilizing mixed logit analysis.
All characteristics affected the likelihood a health system would be preferred, with the exception of the additional tax contribution levels required to finance the system. There were very few missing or inconsistent responses. The direction of preferences was consistent with expectations for both samples; that is, an improvement in attributes describing level of health, equity or responsiveness increased the likelihood that a health system would be preferred.
A number of potential improvements to the preference instrument are suggested. The discrete-choice technique used in this study offers a feasible method for eliciting health system preferences, and its use in a larger-scale study to elicit and compare the preferences of representative population samples is supported.
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Griffith University staff research funds provided the incentive payments for the Australian participants. Funds for the UK arm of the study were provided by York Health Economics Consortium Ltd, a research and consulting company owned by the University of York.
The authors thank Sidi Cisse for his role in conducting the UK interviews and preliminary analysis of that data, and Kent Sweeting for his role in conducting the Australian interviews. The thoughtful comments from the anonymous reviewers of this manuscript played a pivotal role in the final shaping of this article. Thank you for your assistance.
The authors have no conflicts of interest that are directly relevant to the content of this article.
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Scuffham, P.A., Whitty, J.A., Taylor, M. et al. Health system choice. Appl Health Econ Health Policy 8, 89–97 (2010). https://doi.org/10.2165/11531170-000000000-00000
- Health System
- Categorical Attribute
- Patient Choice
- Preference Weight
- Mixed Logit