DEFACTUM, Olof Palmes Alle 15, 8200, Aarhus N, Denmark.
Department of Public Health, Aarhus University, Bartholins Alle 2, bldg. 1260, 8000, Aarhus, Denmark.
Patient. 2018 Dec;11(6):613-624. doi: 10.1007/s40271-018-0313-9.
Free choice of hospital has been introduced in many healthcare systems to accommodate patient preferences and incentivize hospitals to compete; however, little is known about what patients actually prefer.
This study assessed women's preferences for birthing hospital in Denmark by quantifying the utility and trade-offs of hospital attributes.
We conducted a discrete-choice experiment survey with 12 hypothetical scenarios in which women had to choose between three hospitals characterized by five attributes: continuity of midwifery care, availability of a neonatal intensive care unit (NICU), hospital services offered, level of specialization to handle rare events, and travel time. A random parameter logit model was used to estimate the utility and marginal willingness to travel (WTT) for improvements in other hospital attributes.
A total of 517 women completed the survey. Significant preferences were expressed for all attributes (p < 0.01), with the availability of a NICU being the most important driver of women's preferences; women were willing to travel 30 more minutes (95% confidence interval 28-32) to reach a hospital with a highly specialized NICU. The subgroup analyses revealed differences in WTT, with substantial heterogeneity due to prior experience with giving birth and regarding risk attitude and health literacy.
A high specialization level was the most influential factor for women without previous birth experience and for risk-averse individuals but not for women with a high health literacy score. Hence, more information about the woman's risk profile and services required could play a role in affecting hospital choice.
许多医疗保健系统都引入了自由选择医院的政策，以满足患者的偏好并激励医院之间竞争；然而，人们对患者实际上的偏好知之甚少。
本研究通过量化医院属性的效用和权衡，评估丹麦女性选择分娩医院的偏好。
我们进行了一项离散选择实验调查，共有 12 个假设情景，女性必须在 3 家医院之间做出选择，这些医院的特点是 5 个属性：助产士护理的连续性、新生儿重症监护病房（NICU）的可用性、提供的医院服务、处理罕见事件的专业化程度和旅行时间。使用随机参数对数模型估计效用和对其他医院属性改善的边际旅行意愿（WTT）。
共有 517 名女性完成了调查。所有属性都表达了显著的偏好（p<0.01），NICU 的可用性是女性偏好的最重要驱动因素；女性愿意多旅行 30 分钟（95%置信区间 28-32）到达一家拥有高度专业化 NICU 的医院。亚组分析显示了 WTT 的差异，由于之前的分娩经验以及风险态度和健康素养的不同，存在很大的异质性。
对于没有先前分娩经验和风险规避的女性以及风险偏好较低的个体来说，高专业化水平是最具影响力的因素，但对于健康素养得分较高的女性则不然。因此，更多关于女性风险状况和所需服务的信息可能会影响医院选择。
