The use of conjoint analysis to elicit community preferences in public health research: a case study of hospital services in South Australia

Abstract

AimsTo demonstrate the use of conjoint analysis (CA) in public health research through a survey of the South Australian community about aspects of their public hospital services. MethodsA series of focus groups determined the most important attributes in choice of hospital services. These were built into a CA survey, using the discrete choice approach. The survey was posted to a representative sample of 700 South Australians. Theoretical validity, internal consistency and non-response bias were all investigated. ResultsSome 231 individuals returned the questionnaire. The attribute, ‘improvement in complication rates’ was positively associated with choice of hospital. Three attributes were found to be negatively associated with such choice: ‘waiting times for casualty’, ‘waiting times for elective surgery’ and, anomalously, ‘parking and transport facilities’. Travel time’ and the cost attribute, ‘Medicare levy’ were not statistically significant. Trade-offs between the significant attributes were estimated, as were satisfaction or utility scores for different ways of providing hospital services. Results concerning internal consistency and internal validity were encouraging, but some potential for non-response bias was detected. ConclusionA high premium is placed on the quality of hospital care and members of the community are prepared to choose between hospitals largely on the basis of outcomes and length of waiting times for elective surgery and in casualty. ImplicationsCA can yield potentially policy-relevant information about community preferences for health services.