School of Medicine, Griffith University, Meadowbrook, Queensland, Australia.
Appl Health Econ Health Policy. 2010;8(2):89-97. doi: 10.2165/11531170-000000000-00000.
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.
当进行医疗体系改革时，应当考虑公民对理想医疗体系特征的偏好。本研究旨在试点测试一种旨在获取医疗体系属性偏好权重的离散选择工具。一项离散选择实验被设计并分发给来自英国和澳大利亚的两个便利样本（每组 50 人）。利用混合逻辑分析，分析了代表健康水平、公平性、响应性和医疗保健融资的八项医疗体系属性对假设医疗体系之间选择的影响。所有特征都影响了医疗体系被偏好的可能性，除了为融资系统所需的额外纳税额。几乎没有缺失或不一致的响应。两个样本的偏好方向都符合预期；也就是说，描述健康水平、公平性或响应性的属性的改善增加了偏好医疗体系的可能性。建议对偏好工具进行一些改进。本研究中使用的离散选择技术为获取医疗体系偏好提供了一种可行的方法，支持在更大规模的研究中使用该方法来获取和比较代表性人群样本的偏好。
