Abstract
Understanding patients’ preferences for health facilities could help decision makers in designing patient-centered services. Therefore, this study aims to understand how patients’ willingness to trade for certain attributes affects the choice of public health facilities in the Western Cape province of Cape Town, South Africa. A discrete choice experiment was conducted in two community day centers (CDCs). Patients repetitively chose between two hypothetical health facilities that differed in six attributes: distance to facility, treatment by doctors vs. nurses, confidentiality during treatment, availability of medication, first visit (drop-in) waiting times, and appointment waiting times. The sample consisted of 463 participants. The findings showed that availability of medication (50.5%), appointment waiting times (19.5%), and first visit waiting times (10.2%) were the most important factors for patients when choosing a health facility. In addition, respondents preferred shorter appointment and first visit waiting times (<2 h). These results identified important characteristics in choosing public health facilities in Cape Town. These public health facilities could be improved by including patient voices to inform operational and policy decisions in a low-income setting.
Highlights
The World Health Organization (WHO) argues that health systems are made of different components that devote themselves to producing actions whose primary purpose is to improve health [4]
As South Africa moves to adopt National Health Insurance (NHI), the success of this process hinges on public healthcare reforms, which are critical to the delivery of high-quality, accessible, public-sector health services for universal coverage in the health system
This study suggested that treatment by doctors versus nurses, availability of medication, staff attitudes, waiting times, transport costs, expert advice, and examination are important factors influencing the choice of public health facilities
Summary
The choice of where to seek medical care is influenced mainly by personal preferences, illness severity, and economic capacity [1,2]. The World Health Organization (WHO) argues that health systems are made of different components (organizations, institutions, and resources) that devote themselves to producing actions whose primary purpose is to improve health [4]. Most of the South African population access health services through government-run public clinics and hospitals. As South Africa moves to adopt National Health Insurance (NHI), the success of this process hinges on public healthcare reforms, which are critical to the delivery of high-quality, accessible, public-sector health services for universal coverage in the health system. Regardless of whether healthcare services become more affordable and available, people will not use them if the quality of these services is unacceptable [5]. Citizenry criticism of public healthcare is widely documented. Several initiatives such as NHI Public Hearings have been carried out to capture concerns and try to improve the services offered by the government [6,7]
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