基于离散选择实验的医学生就业偏好分析

目的 通过分析医学生就业偏好,为政策制定者和医疗卫生机构出台吸引医学生毕业后继续从事医疗卫生工作的措施提供决策支持。方法 采用分层抽样的方法,于2020年4月在江苏省南京市和连云港市各一所医科类高校开展离散选择实验(discrete choice experiment, DCE)线上问卷调查。问卷包括调查对象基本信息、DCE选择集(共包括工作地点、晋升年限、工作机构、月收入、住房条件、职业发展机会或培训机会、工作负担7个属性,每个属性又包括若干水平)。构建离散选择模型,采用Mixed Logit回归模型分析医学生的就业选择偏好。结果 共回收问卷329份,有效问卷307份,有效回收率93.3%。结果显示,医学生偏好收入高(P<0.001)、住房条件好(P<0.001)、职业发展机会多(P<0.001)、工作地点为城市(P<0.001)、工作负担轻(P<0.001)的工作。月收入是医学生最偏好的因素,医学生对各非经济因素的相对偏好程度由大至小依次为住房条件、职业发展机会或培训机会、工作地点和工作负担。结论 政策制定者与医疗卫生机构应优先关注收入与住房条件,科学...     

基于离散选择实验的公立医院护理人员岗位选择偏好研究

目的 了解公立医院护理岗位新职工岗位选择偏好,为医院合理配置护理人员,完善岗位管理提供参考。方法 选取青岛市4家三级甲等综合医院2021年度招聘的护理新职工进行问卷调查,采用离散选择实验（Discrete Choice Experiment,DCE）的方式编制问卷,问卷涵盖调查对象的基本情况和DCE问题。采用混合Logit模型、支付意愿以及边际效应模型分析新职工对岗位选择的偏好及水平。结果 纳入的6个属性（收入水平、工作氛围、工作环境、工作压力、编制、职业发展前景）对护理新职工岗位选择偏好均有统计学意义。新职工较为关注工作氛围（OR=5.431,P<0.05）这一非经济属性;不同个体特征的新职工对工作氛围、编制、职业发展前景的支付意愿更高;工作属性的改变对岗位选择的边际效应有不同程度影响（P<0.05）。结论 护理新职工对非经济属性的偏好超过了经济属性,新职工更加关注心理状态的满足和岗位发展前景,软环境的改善对提高新职工职业归属感、心理认同感、稳定护理队伍促进医院高质量发展有积极影响。     

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。     

基于离散选择实验的老年居民长期护理保险选择偏好研究

目的：分析老年居民对于长期护理保险不同属性的偏好、支付意愿以及偏好异质性,为构建符合需方偏好的长期护理保险制度提供参考。方法：利用离散选择实验方法设计问卷,以260名老年居民作为研究样本,构建混合Logit模型进行偏好分析。结果：老年居民倾向于在社区/家庭、由高级养老护理员提供“日常生活照料+康复护理+精神护理”的综合服务且报销比例为90%的长期护理保险,为此老年居民分别愿意多支付110.814元、13.959元、27.928元和31.294元。保险属性相对重要性由高到低依次为照护地点、保险报销比例、照护服务内容、照护者职业技能水平。不同性别、文化、配偶、收入的老年居民长期护理保险选择偏好具有异质性。结论：建议立足需方视角,尊重老年居民偏好,制定多样化长期护理保险方案,增强保险吸引力及发展可持续性。     

基于离散选择实验的重度慢性病患者就医偏好研究

目的:了解居民在重度慢性非传染性疾病(以下简称慢性病)假设条件下的就医偏好,分析居民就医偏好的影响因素,为完善慢性病服务供给策略提供依据。方法:基于离散选择实验进行实验设计,运用正交实验设计调查问卷,对成都、贵阳、武汉、许昌、泰州及上海6市的2019名居民进行面对面调查。通过STATA 12.0用混合logit模型对数据进行统计分析。结果:在重度慢性病假设条件下,居民利用医疗服务的偏好效用从大到小依次是:专家(β=0.85)、中西医结合服务(β=0.49)、西医服务(β=0.40)。服务距离对居民利用医疗服务的效用同样影响很大(β=-0.07),只不过是负向的,说明偏好距离近的医疗服务。此外,亚组分析表明,男性、在职、有医疗保险的居民愿意支付更多的费用来接受专家,中西医结合服务。结论:医生类型是居民最为关注的服务属性,中西医结合服务日益受到居民重视。建议构建供给侧改革下慢性病防治策略,提高基层卫生服务机构的服务能力,开设慢性病专家门诊、专科门诊,建立统一的转诊标准并制定慢性病管理的临床路径,促进中医药融入慢性病防治。     

基于离散选择实验的居民家庭医生签约服务偏好研究

目的：研究居民对家庭医生签约服务的偏好。方法：构建离散选择模型,采用混合Logit模型评估居民对家庭医生签约服务的偏好、每个属性的相对重要性以及不同特征居民对家庭医生签约服务的偏好异质性。结果：居民偏好选择每年签约自付费用为20元、诊疗水平高、药品配备高、提供基本服务包及中西医结合服务的家庭医生签约服务,以上属性的相对重要性分别为30.18%、20.95%、22.06%、14.55%、7.55%,不同特征居民偏好存在异质性。结论：加快推进医联体模式下的家庭医生签约服务,适当放开医保政策对签约服务的用药限制,提供“菜单式服务”,提高居民对家庭医生签约服务的认知度与参与度。     

基于离散选择实验的互联网医院诊疗服务偏好研究

[目的]分析居民对互联网医院诊疗服务的偏好,为互联网医院的可持续发展提供参考。[方法]基于离散选择实验方法,以429名居民为调查对象,利用查阅文献、专家咨询的方法确定运营主体、医生推荐指数、就诊方式和服务费用4个属性,采用正交试验设计确定4个选择集和1个“质量控制”选择集。采用网上问卷调查的方式进行数据收集,对得到后的数据进行条件Logit回归分析。[结果]相对于I型的运营主体,居民更愿意H+I型的运营主体(β=0.379),选择H+I型是选择I型的1.461倍(P<0.01);相对于低的医生推荐指数,居民更愿意选择中(β=1.131)、高(β=0.861)医生推荐指数,选择中、高医生推荐指数分别是选择低的医生推荐指数的3.098倍、2.366倍(P<0.01);相对于以图文的问诊方式,居民更愿意选择电话的问诊方式(β=0.539),而不愿意选择视频的问诊方式(β=-0.499),选择电话是选择图文的1.715倍(P<0.01),选择视频是选择图文的0.607倍(P<0.01)。[结论]医生推荐指数是居民选择互联网医院诊疗最看重的属性。建议加强互联网医院人才队伍...     

终末期肾病患者血液透析服务选择偏好研究——基于离散选择实验

目的：研究终末期肾病患者对血液透析服务的选择偏好及影响因素。方法：基于标签式离散选择实验方法设计问卷,通过分层整群抽样方法开展调查,构建混合Logit模型,对408份有效样本进行服务偏好研究。结果：终末期肾病患者对社区血液透析服务具有显著的负向偏好;患者倾向于向上转诊通道流畅有效、医生固定、交通时间20分钟、提供家庭线下随访的血液透析服务,为此分别愿意多支付92.08元、74.52元、47.64元、17.63元;随着服务属性水平累积改变,患者选择社区血液透析服务的概率持续提升。结论：流畅有效的向上转诊通道是患者选择社区透析服务的关键;建议建设紧密型医联体,实现医疗同质化,保障患者安全;改善医患关系连续性,提高延续服务质量。     

乡镇卫生院护理人员工作偏好研究:基于离散选择实验

目的 :通过分析乡镇卫生院护理人员工作偏好,为基层留住护理人员提供政策参考。方法 :基于离散选择实验的方法,抽取山东、安徽、陕西三省共164名乡镇卫生院护理人员进行问卷调查,利用条件logistic模型进行分析。结果 :纳入分析的6项工作属性都具有统计学显著性(P0.001)。其中月收入8 000元与2 000元相比,留在基层工作的OR为12.16,子女有好教育条件与没有相比,OR为10.59,有编制与无编制相比,OR为7.81。"月收入4 000元+提供编制"和"月收入4 000元+改善子女教育条件"两种干预组和,预计能保留98%以上的基层护理人员。结论 :对乡镇卫生院护理人员来说,最重要的工作属性是收入水平、子女教育条件和编制。根据离散选择实验结果所设计的政策干预包将为基层护理人力保留政策发展提供重要参考。     

Demand for Cancer Screening Services: Results From Randomized Controlled Discrete Choice Experiments

ObjectivesLow uptake of cancer screening services is a global concern. Our aim was to understand factors that influence the screening decision, including screening and treatment subsidies and a gain-frame message designed to present screening as a win–win.MethodsWe analyzed preferences for mammography and Pap smear among women in Singapore by means of discrete choice experiments while randomly exposing half of respondents to a gain-framed public health message promoting the benefits of screening.ResultsResults showed that the message did not influence stated uptake, and given the levels shown, respondents were influenced more by treatment attributes, including effectiveness and out-of-pocket cost should they test positive, than by screening attributes, including the offer of a monetary incentive for screening. Respondents also underestimated the survival chances of screen-detected breast and cervical cancers.ConclusionsCombined, these findings suggest that correcting misconceptions about screen-detected cancer prognosis or providing greater financial protection for those who test positive could be more effective and more cost-effective than subsidizing screening directly in increasing screening uptakes.     

Labeled versus Unlabeled Discrete Choice Experiments in Health Economics: An Application to Colorectal Cancer Screening

ObjectivesDiscrete choice experiments (DCEs) in health economics commonly present choice sets in an unlabeled form. Labeled choice sets are less abstract and may increase the validity of the results. We empirically compared the feasibility, respondents' trading behavior, and convergent validity between a labeled and an unlabeled DCE for colorectal cancer (CRC) screening programs in The Netherlands.MethodsA labeled DCE version presented CRC screening test alternatives as “fecal occult blood test,” “sigmoidoscopy,” and “colonoscopy,” whereas the unlabeled DCE version presented them as “screening test A” and “screening test B.” Questionnaires were sent to participants and nonparticipants in CRC screening.ResultsTotal response rate was 276 (39%) out of 712 and 1033 (46%) out of 2267 for unlabeled and labeled DCEs, respectively (P < 0.001). The labels played a significant role in individual choices; approximately 22% of subjects had dominant preferences for screening test labels. The convergent validity was modest to low (participants in CRC screening: r = 0.54; P = 0.01; nonparticipants: r = 0.17; P = 0.45) largely because of different preferences for screening frequency.ConclusionThis study provides important insights in the feasibility and difference in results from labeled and unlabeled DCEs. The inclusion of labels appeared to play a significant role in individual choices but reduced the attention respondents give to the attributes. As a result, unlabeled DCEs may be more suitable to investigate trade-offs between attributes and for respondents who do not have familiarity with the alternative labels, whereas labeled DCEs may be more suitable to explain real-life choices such as uptake of cancer screening.     

Patient Preferences for Anxiety and Depression Screening in Cancer Care: A Discrete Choice Experiment

ObjectivesScreening for anxiety and depression in cancer care is recommended, as identification is the first step in managing anxiety and depression. Nevertheless, patient preferences for anxiety and depression screening in cancer care are unknown. The objective of this study was to investigate and identify the aspects of an anxiety and depression screening program cancer patients value most, to inform decision-makers about ways to improve patient uptake and ultimately, the provision of patient-centered care.MethodsA discrete choice experiment was designed and implemented within an Australian cancer population sample. Participants were presented with a series of hypothetical screening programs labeled as “screening program 1” and “screening program 2” and were asked to choose their preferred one. The discrete choice experiment was administered using an online survey platform. A mixed logit and a latent class analysis was conducted.ResultsParticipants (n = 294) preferred screening to be conducted by a cancer nurse, face-to-face, and at regular intervals (monthly or every 3 months). Participants also preferred follow-up care to be delivered by mental health professionals embedded within the cancer care team. Factors that influenced preferences were the low cost and short waiting times for access to care.ConclusionsCancer patients prefer cancer services with integrated mental healthcare services. To maximize patient uptake, anxiety and depression screening programs should be routinely offered, delivered by oncology healthcare staff in a face-to-face format, and, postscreening, to be care for by mental health professionals embedded within the cancer service.     

Heterogeneous Preferences for Colorectal Cancer Screening in Germany: Results of a Discrete Choice Experiment

ObjectivesColorectal cancer (CRC) screening tests differ in benefits, harms, and processes, making individual informed decisions preference based. The objective was to analyze the preferences of insurees in Germany for characteristics of CRC screening modalities.MethodsA generic discrete choice experiment with 2-alternative choice sets and 6 attributes (CRC mortality, CRC incidence, complications, preparation, need for transportation, and follow-up; 3 levels each) depicting characteristics of fecal testing, sigmoidoscopy, and colonoscopy was generated. Participants completed 8 choice tasks. Internal validity was tested using a within-set dominated pair. Between June and October 2020, written questionnaires were sent to a stratified random sample (n = 5000) of 50-, 55-, and 60-year-old insurees of the AOK (Allgemeine Ortskrankenkasse) Lower Saxony, who had previously received an invitation to participate in the organized screening program including evidence-based information. Preferences were analyzed using conditional logit, mixed logit, and latent-class model.ResultsFrom 1282 questionnaires received (26% [1282 of 4945]), 1142 were included in the analysis. Approximately 42% of the respondents chose the dominated alternative in the internal validity test. Three heterogeneous preference classes were identified. Most important attributes were preparation (class 1; n = 505, 44%), CRC mortality (class 2; n = 347, 30%), and CRC incidence (class 3; n = 290, 25%). Contrary to a priori expectations, a higher effort was preferred for bowel cleansing (class 1) and accompaniment home (classes 1 and 2).ConclusionInternal validity issues of choice data need further research and warrant attention in future discrete choice experiment surveys. The observed preference heterogeneity suggests different informational needs, although the underlying reasons remained unclear.     

The Impact of Environmental Sustainability Labels on Willingness-to-Pay for Foods: A Systematic Review and Meta-Analysis of Discrete Choice Experiments

Food production is a major contributor to environmental damage. More environmentally sustainable foods could incur higher costs for consumers. In this review, we explore whether consumers are willing to pay (WTP) more for foods with environmental sustainability labels (‘ecolabels’). Six electronic databases were searched for experiments on consumers’ willingness to pay for ecolabelled food. Monetary values were converted to Purchasing Power Parity dollars and adjusted for country-specific inflation. Studies were meta-analysed and effect sizes with confidence intervals were calculated for the whole sample and for pre-specified subgroups defined as meat-dairy, seafood, and fruits-vegetables-nuts. Meta-regressions tested the role of label attributes and demographic characteristics on participants’ WTP. Forty-three discrete choice experiments (DCEs) with 41,777 participants were eligible for inclusion. Thirty-five DCEs (n = 35,725) had usable data for the meta-analysis. Participants were willing to pay a premium of 3.79 PPP$/kg (95%CI 2.7, 4.89, p ≤ 0.001) for ecolabelled foods. WTP was higher for organic labels compared to other labels. Women and people with lower levels of education expressed higher WTP. Ecolabels may increase consumers’ willingness to pay more for environmentally sustainable products and could be part of a strategy to encourage a transition to more sustainable diets.     

The Role of Attribute Screening and Choice Set Formation in Health Discrete Choice Experiments: Modeling the Impact of Benefit and Risk Attributes

ObjectivesThis study aimed to demonstrate the econometric modeling of benefit/risk-based choice set formation (CSF) within health-related discrete choice experiments.MethodsIn 4 different case studies, first, a trade-off model was fitted; building on this, a screening model was fitted; and finally, a full CSF model was estimated. This final model allows for attributes to be used first to screen out alternatives from choice tasks before respondents’ trade-off attributes and make a choice among feasible alternatives. Educational level and health literacy of respondents were accounted for in all models.ResultsModel fit in terms of log likelihood, pseudo-R², Akaike information criterion, and Bayesian information criterion improved from using only trade-off or screening models compared with CSF models in 3 of the 4 case studies. In those studies, significant screening behavior was identified that (1) affected trade-off inferences, (2) rejects the pure trade-off model, and (3) supports the existence of screening on the basis of benefit-risk profiles, and other attributes. Educational level and health literacy showed significant interactions with multiple attributes in all case studies.ConclusionsChoice modelers should pay close attention to noncompensatory respondent behavior when they include benefit or risk attributes in their discrete choice experiment. Further studies should investigate why and when respondents undertake screening behavior. Screening behavior in choice data analysis is always a possibility, so researchers should explore extensions of econometric models to reflect noncompensatory behavior. Assuming that benefit and risk attributes will only affect trade-off behavior is likely to lead to biased conclusions about benefit or risk-based behavior.     

离散选择实验模型在卫生人力资源研究中的应用

目的整合目前国内外离散选择实验模型（DCE）在卫生人力资源研究中的运用情况,以及DCE在人力资源研究中的优缺点和初步效果。方法通过对目前国内外一些研究的回顾,在概念、运用方法和步骤等方面进行了总结。结果研究发现,DCE可运用于测量医疗卫生工作者的工作意向,研究某一项工作特征的改变对选择工作的影响程度和某一项工作中某个属性特征水平的货币价值。建议在卫生人力资源研究中,可以利用DCE帮助进行相关的卫生政策的制定和实施。