Danyliv Andriy, Pavlova Milena, Gryga Irena, Groot Wim
School of Public Health, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine.
Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.
Int J Health Plann Manage. 2015 Oct-Dec;30(4):346-65. doi: 10.1002/hpm.2239. Epub 2014 Jan 8.
Evidence on preferences of Ukrainian consumers for healthcare improvements can help to design reforms that correspond to societal priorities. This study aims to elicit and to place monetary values on public preferences for out-patient physician services in Ukraine. The method of discrete choice experiment is used on a sample of 303 respondents, representative of the adult Ukrainian population. The random effect logit model with interactions provides the best fit for the data and is used to calculate the marginal willingness to pay (MWTP) for quality and access improvements. At a sample level, there is no clear preference to pay formally rather than informally or vice versa. We also do not find that visiting a general practitioner is preferred over direct access to a medical specialist. However, there are differences between population groups. Quality-related attributes of physician services appear important to respondents, especially the attitude of medical staff. Thus, interpersonal aspects of out-patient care should be given priority in decisions about investments in quality improvements. Other aspects, that is social quality and access, are important as well but their improvement brings fewer social gains. Measures should be taken to eradicate the informal payment channels and to strengthen the gate-keeping role of primary care.
有关乌克兰消费者对医疗改善偏好的证据有助于设计符合社会优先事项的改革。本研究旨在引出乌克兰公众对门诊医生服务的偏好并赋予其货币价值。离散选择实验方法应用于303名受访者的样本，该样本代表乌克兰成年人口。带有交互项的随机效应logit模型最适合该数据，并用于计算质量和可及性改善的边际支付意愿（MWTP）。在样本层面，没有明显倾向于选择正式付费而非非正式付费，反之亦然。我们也没有发现看全科医生比直接看专科医生更受青睐。然而，不同人群之间存在差异。医生服务中与质量相关的属性对受访者似乎很重要，尤其是医务人员的态度。因此，在决定质量改善投资时，门诊护理的人际方面应被优先考虑。其他方面，即社会质量和可及性也很重要，但它们的改善带来的社会收益较少。应采取措施根除非正式支付渠道，并加强初级保健的守门作用。
