Centre for the Study of Choice (CenSoC), University of Technology Sydney, Sydney, New South Wales, Australia.
Patient. 2010 Dec 1;3(4):275-83. doi: 10.2165/11539660-000000000-00000.
: One of the greatest difficulties in evaluating healthcare system reform in any country is that governments often do not clearly articulate what it is they are attempting to do. In Australia, a recent inquiry set out 15 principles to guide the reform process, but it remains unclear how the Australian public values the principles, how such values vary across the country, and, more fundamentally, if Australians understand the principles.
: To evaluate the Australian healthcare reform principles from the perspective of the Australian public, to test if such preferences are valued consistently across geographic and socioeconomic strata, and to test for the degree of understanding of the principles among the public.
: We employed best-worst scaling (BWS), a stated-preference method grounded in random utility theory, to elicit public preference for 15 healthcare reform principles. The BWS tasks were incorporated into an online survey that also gathered geographic and socioeconomic information and included questions relating to the understanding of the reform principles. Respondents were a geographically diverse set of Australians who were randomized to receive one of two versions of the survey, each containing a block of 15 choice tasks. Tasks in block one contained a subset of the choice tasks containing subsets of seven principles based on a balanced incomplete block design, while tasks in block two contained tasks with eight principles defined by the complement of the former.In each BWS task, respondents were simply asked to identify the most and least important principle. Analysis of preference was based on assigning the most valued principles a '1' and the least valued principles '-1', and with each item appearing eight times in each block, preferences were analyzed over a cardinal utility scale bounded by -8 and +8. Analysis was based on simple summary statistics and stratified by geographic and socioeconomic measures.
: A sample of 204 respondents participated in the survey (a participation rate of 85%). Quality and safety was the most important principle and a culture of reflective improvement and innovation was the least important. Public voice and community engagement was the second least important principle and was also understood by barely half the respondents.
: This research demonstrates how random-utility-based methods can be used to provide estimates of the importance of reform principles that have known statistical properties. The BWS task used forced respondents to discriminate between the principles on offer, unlike rating scales. Researchers and practitioners in healthcare should consider using BWS tasks in preference to rating scales.
评估任何国家医疗体系改革的最大困难之一是政府往往没有明确说明他们试图做什么。在澳大利亚，最近的一项调查提出了 15 项原则来指导改革进程，但仍不清楚澳大利亚公众如何看待这些原则，这些价值观在全国范围内的差异，以及更根本的是，澳大利亚人是否理解这些原则。
从澳大利亚公众的角度评估澳大利亚医疗改革原则，检验这些偏好是否在地理和社会经济阶层之间一致，以及检验公众对这些原则的理解程度。
我们采用了最佳最差评分法（BWS），这是一种基于随机效用理论的陈述偏好方法，以了解公众对 15 项医疗改革原则的偏好。BWS 任务被纳入一项在线调查中，该调查还收集了地理和社会经济信息，并包括与改革原则理解相关的问题。受访者是来自澳大利亚各地的一组具有代表性的人群，他们被随机分配到接受调查的两种版本之一，每个版本都包含一组 15 个选择任务。第一组任务中的选择任务包含基于平衡不完全区块设计的七个原则的子集，而第二组任务中的选择任务包含由前者的补集定义的八个原则。在每个 BWS 任务中，受访者只需被要求确定最重要和最不重要的原则。偏好分析是基于将最有价值的原则赋值为“1”，将最不重要的原则赋值为“-1”，并且每个项目在每个区块中出现八次，偏好是在一个由-8 和+8 定义的基数效用标度上进行分析。分析基于简单的汇总统计数据，并按地理和社会经济措施进行分层。
204 名受访者参与了调查（参与率为 85%）。质量和安全是最重要的原则，而 reflective improvement 和 innovation 的文化是最不重要的原则。公众声音和社区参与是第二不重要的原则，也只有不到一半的受访者理解。
这项研究展示了如何使用基于随机效用的方法来提供对具有已知统计属性的改革原则的重要性的估计。BWS 任务迫使受访者在提供的原则之间进行区分，这与评分量表不同。医疗保健领域的研究人员和从业者应该考虑使用 BWS 任务而不是评分量表。
