Determinants of the choice of GP practice registration in England: Evidence from a discrete choice experiment

There have been growing concerns that general practitioner (GP) services in England, which are based on registration with a single practice located near the patient's home, are not sufficiently convenient for patients. To inform the decision as to whether to change registration rules allowing patients to register ‘out-of-area’ and to estimate the demand for this wider choice, we undertook a discrete choice experiment with 1706 respondents. Latent class models were used to analyse preferences for GP practice registration comparing preferences for neighbourhood and non-neighbourhood practices. We find that there is some appetite for registering outside the neighbourhood, but this preference is not uniformly shared across the population. Specifically individuals who are less mobile (e.g. older people and those with caring responsibilities), or satisfied with their local practice are less likely to be interested in registering at a practice outside their neighbourhood. Overall, people feel most strongly about obtaining an appointment with a GP as quickly as possible. Respondents regarded weekend opening as less important than other factors, and particularly less important than extended practice opening hours from Monday to Friday. Assuming a constant demand for GP services, a policy encouraging GP practices to extend their opening hours during the week is likely to decrease the average patient waiting time for an appointment and is likely to be preferred by patients.     

乡村医生学习和使用中医药适宜技术的偏好研究

目的：分析乡村医生学习和使用中医药适宜技术的偏好,探讨促进其学习和使用中医药适宜技术积极性的建议,为推动中医药适宜技术在乡村医疗机构的扩散提供参考。方法：采用方便抽样的方法调研了我国17个省236家村卫生室的310名乡村医生,建立条件logit模型进行数据分析,并计算支付意愿和相对重要性。结果：学习的自费费用(β=-0.116)、技术的疗效预期(β=0.493)、学习难度、学习方式、学习单项技术耗时效用显著影响乡村医生学习中医药适宜技术的偏好;月收入的改变(β=0.062)、技术的疗效(β=0.737)、医保(β=0.575)、病人自费费用的改变(β=0.420)、技术单次操作时间、工作负担的改变效用显著影响乡村医生使用中医药适宜技术的偏好;乡村医生在实际学习和使用中医药适宜技术的过程中,还存在许多不足,尤其是自费学习普遍(47.06%)和多种技术不在医保报销范围内(52.94%)的问题。结论：乡村医生对免费学习、能够增加收入、疗效更高、更为简单且能够降低患者疾病经济负担的中医药适宜技术有更好的选择偏好。建议：尽可能降低乡村医生学习中医药适宜技术的经济负担;对使用中医药适宜技术者适当给...     

贫困地区乡镇卫生院医生工作选择偏好——基于福建两贫困县的Mixed Logit模型分析

目的:了解贫困地区乡镇卫生院医生工作选择偏好。方法:基于离散选择实验思路设计问卷,抽取160名贫困地区乡镇卫生院医生填写问卷,应用Mixed Logit模型进行分析。结果:贫困地区乡镇卫生院医生对工资、编制、子女教育条件、预期工作年限有显著正偏好,对职称晋升年限具有显著负偏好。所有的工作属性变量都存在偏好的异质性,尤为显著的是预期工作年限,其中68%的医生选择较长的工作年限,32%的医生则相反。子女教育条件和编制的货币价值为5 141元和2 181元。为医生子女提供当地最好的教育条件可使工作选择比例提升38.06%。结论:多数在职的贫困地区乡镇卫生院医生有继续在岗工作的意愿。除工资外,子女教育条件等非经济因素对医生工作选择有较大影响。     

Eliciting preferences for medical devices in South Korea: A discrete choice experiment

This study aims to identify the attributes that contribute to the value of medical devices and quantify the relative importance of them using a discrete choice experiment. Based on a literature review and expert consultation, seven attributes and their levels were identified—severity of disease (2), availability of substitutes (2), improvement in procedure (3), improvement in clinical outcomes (2), increase in survival (2), improvement in quality of life (3), and cost (4). Among 576 hypothetical profiles, optimal choice sets with 20 choices were developed and experts experienced in health technology assessment and reimbursement decision making in South Korea were surveyed. A total of 102 respondents participated in the survey. The results of the random-effect probit model showed that among the seven attributes, six, except for improvement in procedure, had a significant impact on respondents’ choices on medical devices. Respondents were willing to pay the highest amount for devices that provided substantial improvements in quality of life, followed by increased survival, improved clinical outcome, treatment without substitutes, and technology for treating severe diseases. The findings of this experiment will inform decision-makers of the relative importance of the criteria and help them in reimbursement decision making of medical devices.     

Modelling heterogeneity in patients' preferences for the attributes of a general practitioner appointment

This paper examines the distribution of preferences among respondents to a discrete choice experiment on the choice of general practitioner appointments. In addition to standard logit, mixed and latent class logit models are used to analyse the data from the choice experiment. It is found that there is significant preference heterogeneity for all the attributes in the experiment and that both the mixed and latent class models lead to significant improvements in fit compared to the standard logit model. Moreover, the distribution of preferences implied by the preferred mixed and latent class models is similar for many attributes.     

Girls’ preferences for HPV vaccination: A discrete choice experiment

A discrete choice experiment was developed to investigate if girls aged 12–16 years make trade-offs between various aspects of human papillomavirus (HPV) vaccination, and to elicit the relative weight that girls’ place on these characteristics. Degree of protection against cervical cancer, protection duration, risk of side-effects, and age of vaccination, all proved to influence girls’ preferences for HPV vaccination. We found that girls were willing to trade-off 38% protection against cervical cancer to obtain a lifetime protection instead of a protection duration of 6 years, or 17% to obtain an HPV vaccination with a 1 per 750,000 instead of 1 per 150,000 risk of serious side-effects. We conclude that girls indeed made a trade-off between degree of protection and other vaccine characteristics, and that uptake of HPV vaccination may change considerably if girls are supplied with new evidence-based information about the degree of protection against cervical cancer, the protection duration, and the risk of serious side-effects.     

山东省地市级疾控人员工作偏好研究：基于离散选择实验

目的：探讨地市级疾病预防控制中心人员的工作偏好,为制定有效的激励机制提供依据。方法：本研究采用分层抽样和立意抽样相结合的方法,线上调研山东省6个地市级疾控机构的455名工作人员,利用混合Logit模型和潜在类别模型分析数据,并计算支付意愿和相对重要性。结果：混合Logit模型中,收入、福利水平、编制、工作量、群众的认可与尊重、个人职业发展机会和培训机会均对疾控人员的工作偏好有显著影响(P<0.05),其中编制(β=2.636)和收入(β=0.083)等保健因素较激励因素影响程度大。潜在类别模型显示,相对年轻、月收入较低的疾控人群更重视收入;年龄较大、月收入较高的疾控人群更重视编制。结论：地市级疾控人员偏好有编制、收入较高、福利水平很好、群众认可且尊重、工作量少、个人职业发展机会较多和培训机会丰富的工作。建议合理控制并动态调整编制总量,平衡编制内外工作条件的差异;增加对疾控的财政投入,改善薪酬绩效体系;同时重视保健因素和激励因素,多种手段共同激励疾控人员发展;对不同类别的疾控人员采用差异化的激励措施。     

基于离散选择实验的医生互联网诊疗服务选择偏好研究

目的：研究医生互联网医院诊疗服务的选择偏好及其影响因素,了解医生参与互联网医院诊疗服务的偏好、意愿和需求。方法：应用离散选择实验方式,抽取北京市2所综合医院及3所专科医院共119位医生进行问卷调查,应用条件Logit回归分析其选择偏好。结果：医生支付意愿从高到低为：医生对线上诊疗绩效分成比例较线下的变化、每日工作时长、响应时间。不同年龄、职称、工作年限及科室的医生选择偏好存在差异。结论：医生更偏向于在线上诊疗绩效分成比例较线下增加20%、互联网诊疗服务占年度考核的权重占比增加10%、每日工作时长为线下减少1小时同时线上增加1小时、响应时间为24小时以内的情形下选择互联网医院诊疗服务。可对医生采取经济激励和非经济激励相结合、合理分配工作量等激励机制,满足医生的偏好和需求,促进互联网医院高质量发展。     

中国农村基本卫生保健工作发展与思考

目的：了解我国农村地区基本卫生保健工作的现状,以及在新世纪第一个十年中取得的成绩和存在的问题,为进一步推进农村基本卫生保健工作提出有针对性的政策建议。方法：按照分层抽样的方法,在全国选择400个县级行政单位,收集当地农村基本卫生保健工作的相关数据。结果与发现：（1）农村基本卫生保健工作得到政府重视,但财政保障仍不足;（2）乡村两级医疗卫生服务体系建设仍需不断完善;（3）基本公共卫生服务在医改政策推动下进展明显,后续要加大力度推进;（4）新型农村合作医疗制度不断完善;（5）基本药物制度实施使基层医疗卫生机构面临发展困境。     

Intergroup communication between hospital doctors: Implications for quality of patient care

Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed by social identity and communication accommodation theories of doctors' experiences of managing such patients, to explore the impact of communication. Interviews were undertaken with 45 doctors working in a large metropolitan hospital, and were analysed using Leximancer (text mining software) and interpretation of major themes. Findings indicated that intergroup conflict is a central influence on communication. Contested responsibilities emerged from a model of care driven by single-specialty ownership of the patient, with doctors allowed to evade responsibility for patients over whom they had no sense of ownership. Counter-accommodative communication, particularly involving interpersonal control, appeared as important for reinforcing social identity and winning conflicts. Strategies to resolve intergroup conflict must address structural issues generating an intergroup climate and evoke interpersonal salience to moderate their effect.     

公立医院医生开展互联网医疗服务的偏好研究——基于离散选择实验

目的：通过调查公立医院医生对开展互联网医疗的选择偏好,探讨影响医生开展互联网医疗的因素,以期为公立互联网医院的运营优化提供参考。方法：基于离散选择实验方法,确定服务时间、服务模式、服务方式、服务项目和服务收费5个属性,采用正交试验设计确定8个选择集。采用网上问卷调查的方式进行数据收集,对得到的数据利用基于Cox比例风险模型参数估计的条件logit回归分析进行统计分析。结果：服务时间上,医生更愿意选择碎片化时间服务;服务方式上,医生更愿意以图文方式开展互联网诊疗;服务项目上,医生更愿意提供线上咨询服务;服务收费上,医生更愿意服务收费为与线下门诊持平或高于线下门诊。结论：建议创新服务模式,合理分配与调度线上线下医生资源;根据互联网医患沟通特点,优化线上诊疗服务方式和服务项目。加快互联网医疗服务价格管理的政策保障体系建设,合理补偿互联网医疗服务成本。     

Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders preferences

Background

The trade-off between efficiency and equity has been largely studied in the health economics literature and for countries with different types of health systems. Even if efficiency and equity are desired, it is not always feasible to attain both simultaneously. In Spain, the National Health System has historically been recognized for its universal access and free of charge provision, with good health outcomes. However, the recent increase in health expenditures together with the economic cycle has turned the orientation of health policy implementation towards efficiency, threatening universality and equity in the access to healthcare.

为郊区农村定向培养医生的探讨

当前农村医疗卫生人才培养面临着严峻的挑战，应届毕业生到贫困山区工作的甚少，农村医疗卫生人才缺乏。建立面向农村山区和贫困地区定向招生、定向就业的医疗卫生人才培训基地，是在短期内解决农村基层医疗卫生人才匮乏的有效机制，促进了具有特色的面向农村基层培养临床医学专业人才课程体系的建设。建立城市医疗卫生人力资源支持农村医疗卫生事业发展的长效机制，对发展农村在职教育和非学历培训提供了强有力的保障。     

Health care access in rural areas: Evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality

We examined whether levels of rurality are associated with hospitalization for ambulatory care-sensitive conditions (ACSH) in eight states of the United States. ACSH is an indicator of access to reasonably effective primary health care. ACSH for children did not vary systematically with rurality. Compared to the most urban counties, the adjusted rate in the most rural was 90% greater for ages 18–64 and 45% greater for ages 65+ (both p<.001). Adjusted adult rates generally increased with the level of rurality.

Conclusions

Increasing levels of rurality may be positively associated with ACSH, suggesting rural disparities in access to primary health care.     

不同生源地医学生就业偏好及异质性研究——基于北京市6家医院的离散选择实验

目的：分析不同生源地医学生就业偏好及异质性,为优化基层卫生人力管理提供参考。方法：采用整群抽样方法,对北京市6家教学医院的925名医学生开展离散选择实验的线上问卷调查,获得有效问卷741份,有效回收率为80.1%。运用混合logit模型对6个工作属性进行回归分析并估计支付意愿。结果：不同生源地医学生对工作地点的选择具有显著差异。亚组分析结果表明,相比于来自城市的医学生,来自农村和县城的医学生更重视充足的职业发展机会;本科生亚组结果显示,相比于其他生源地的本科生,来自农村的本科生更偏好良好的工作环境。结论：不同生源地的医学生就业偏好存在异质性;政策制定者应关注医学生生源地,兼顾教育程度优化多元工作要素,分类制定针对性的基层卫生人才吸引措施。     

Understanding the role of personal experiences and contextual variables in shaping risk reduction preferences

This article explores how preferences for risk reduction during the COVID-19 pandemic are influenced by personal experiences and contextual variables such as having a close friend or relative who has been infected by the virus (closeness), the severity of the illness (severity), people’s own perceptions of being in a risky group (risk group), change in employment status due to the pandemic (employment situation), and vaccination status (vaccination status and altruistic vaccination). We conducted a choice experiment (CE) in Chile, Colombia, and Costa Rica. The attributes of the experiment were risk reduction, latency, and cost. Then, we estimated a mixed logit model to capture preference heterogeneity across the countries. The attributes presented in the CE were statistically significant, with the expected sign in each country. The variables closeness and employment situation presented homogeneous behavior in each country; however, severity, risk group, and vaccination status showed mixed results. We found that preferences were more heterogeneous for the attributes of the CE than for the personal experiences and contextual variables. Understanding the impact of these variables is essential for generating more effective risk reduction policies. For instance, methodologies such as the value of statistical life base their calculations on society's valuation of risk reduction. We provide evidence that the preferences for risk reduction vary due to the everyday situations that individuals face in the context of the pandemic. The latter may cause distortions in the values used to evaluate policies aimed at mitigating the outbreak.     

Parent's preferences for unscheduled paediatric healthcare: A discrete choice experiment

Background

Unscheduled healthcare is a key component of healthcare delivery and makes up a significant proportion of healthcare access, with children being particularly high users of unscheduled healthcare. Understanding the relative importance of factors that influence this behaviour and decision-making is fundamental to ensuring the system is best designed to meet the needs of users and foster appropriate cost-effective usage of health system resources.

Objective

The aim of the study was to identify the parent's preferences for unscheduled healthcare for a common mild childhood illness.

Design

A discrete choice experiment (DCE) was developed to identify the preferences of parents accessing unscheduled healthcare for their children.

Setting and Participants

Data were collected from parents in Ireland (N = 458) to elicit preferences across five attributes: timeliness, appointment type, healthcare professional attended, telephone guidance before attending and cost.

Results

Using a random parameters logit model, all attributes were statistically significant, cost (β = −5.064, 95% confidence interval, CI [−5.60, −4.53]), same-day (β = 1.386, 95% CI [1.19, 1.58]) or next-day access (β = 0.857, 95% CI [0.73, 0.98]), coupled with care by their own general practitioner (β = 0.748, 95% CI [0.61, 0.89]), identified as the strongest preferences of parents accessing unscheduled healthcare for their children.

Discussion

The results have implications for policy development and implementation initiatives that seek to improve unscheduled health services as understanding how parents use these services can maximise their effectiveness.

Patient or Public Contribution

The development of the DCE included a qualitative research component to ensure that the content accurately reflected parents experiences when seeking healthcare. Before data collection, a pilot test was carried out with the target population to gather their views on the survey.     

Preferences for long-term care services: Willingness to pay estimates derived from a discrete choice experiment

Ageing populations increase pressure on long-term care. Optimal resource allocation requires an optimal mix of care services based on costs and benefits. Contrary to costs, benefits remain largely unknown. This study elicits preferences in the general elderly population for long-term care services for varying types of patients.