Preferences For Health Services Research Articles

Consumer Preferences for Health Services Offered by Health Insurance Companies in Germany

Abstract German health insurance companies increasingly strive to position themselves as health partners to their customers to improve customers’ health and contain costs. However, there is uncertainty about customers’ preferences for health services offered by health insurance companies. Therefore, this paper studies consumer preferences for health services that are or could be provided by health insurance companies in Germany. An online survey was conducted using two stated preference techniques to collect and analyze the data (namely, rating and ranking of health services considered by insurance companies). A sample of 880 German health insurance customers between 18 and 65 years old filled out the online questionnaire, of which 860 submitted complete responses. Ordinal logistic regression analysis was used for the rating and ranking. Preliminary examinations, care management, and health programs were the three health services most important to the respondents. The results suggest that people want their health insurance to support them with preventive health services that offer direct therapeutic value and not just informational, economic, access-related, or convenience-related benefits. These preferences for health services are homogeneous for most subgroups of the population, implying that health insurance companies could consider an overall strategy to address these preferences for all clients by focusing on the important health services. Key messages • People value health services provided by health insurers that offer direct therapeutic value over those that offer only informational, economic, access or convenience benefits. • As preferences are homogeneous across the population, insurers could consider an overall strategy by focusing on the important health services.

Preferences for sexual health services among middle-aged and older adults in the UK: a discrete choice experiment

ObjectivesSexual health is an integral part of well-being. However, the sexual health needs and desires of middle-aged and older adults have been largely disregarded. Therefore, this study aimed to understand...

Consumer Preferences for Health Services Offered by Health Insurance Companies in Germany

Consumer Preferences for Health Services Offered by Health Insurance Companies in Germany

Measuring Mental Health Service Preferences Amongst Illinois Dairy Producers

ABSTRACT Objectives To mitigate mental health concerns of farmers, research is needed to investigate strategies that encourage help-seeking behavior in this population. This study attempts to identify those help-seeking strategies. Six mental health service options were examined. Methods A survey, implementing a best-worst scaling choice experiment, was disseminated to members of the Illinois Milk Producers Association. Two methods of analysis were conducted. The first, a count-based method, employs a simple count-based approach to measure the relative preferences for the six mental health service options in question. The second is more complex and employs a latent-class logit regression model to measure individual preferences. Results The mental-health service options, ranked in order from most preferred to least preferred were: 1) speak to family and friends, 2) keep it to myself, 3) utilize programs offered by agricultural organizations, 4) search online for self-help resources, 5) talk to a mental health professional, and 6) use “tele-health” support services. Conclusion This study examined an important gap in the literature concerning help-seeking preferences of dairy farmers. It is the first to utilize a choice experiment approach to assess help-seeking preferences among this understudied population. Results provide important empirical evidence to support distinct categories of farmers who may be weighing options regarding how to best address their mental health concerns.

Preferences for accessing sexual health services among middle-aged and older adults in the UK: a study protocol for a discrete choice experiment using mixed methods

IntroductionSexual health is essential for general health and well-being. Sexual health services for middle-aged and older adults are not prioritised and optimising available services for this population is often overlooked....

ASSESMENT OF YOUTH REPRODUCTIVE HEALTH SERVICE PREFERENCES, ARAB BORDADE HEALTH CENTER GUMBI BORDERED WOREDA WEST HARARGHE, OROMIA REGION, ETHIOPIA

Introduction; Worldwide, young women and men suffer a disproportionate share of reproductive health problems, such as unplanned pregnancies, sexually transmitted diseases, including HIV/AIDS, and other serious reproductive health problems. Youth Reproductive Health Service is a special gift from the youth age group, young people all over the world are in need of much better education and health care related to reproduction. Methodology; This cross-sectional community based descriptive study was conducted in West Hararghe, Gumbi Bordade woreda Arba Bordade Health Center, with the main objectives of assessing youth reproductive health service preferences and utilization. Based on probability proportionate to the population size of kebele, the lottery method was used to identify the study population by interviewing 239 youth selected by systematic sampling using per-structured questionnaires Result-. A total of 239 youth aged 15-24, 221 responded to the structured questionnaire, out of which 114 (51.6%) were male, with a male to female ratio of 1.14:1. Among the study participants, 140 (63.3%) were aged 15-19, and 38 (17.2%) were married. In the assessment of utilization and preference of the health institution, 96(43.4%) of the respondents preferred to be served in governmental health institution and 69 (31.2%) of the youth indicated the need to rearrange in the existing health institution having separate youth health institution, and 93(42.1%) of the them preferred to be served by young and of the same sex. Conclusions: -A high figure of the youth not served in the existing health institution for their reproductive health needs, even those who used to be served, they claimed that the existing health institutions were inconvenient and unattractive. Almost half of the respondents preferred the need for rearrangement of youth reproductive health institutions separately, and also to be served by young and the same sex health providers. Family health service, sexual education, partner relation guidance, information and education on STD/HIV AIDS and to having an information center were preferred by almost by all respondents.

Do individuals’ health preferences validate the decentralisation of the public health system in Spain?

The objective of this paper is to estimate individuals’ preferences about public health services in two Spanish regions, the Basque Country (BC) and Canary Islands (CI) and analyse whether they differ. This work was motivated by the actual economic situation, where it is necessary to obtain equilibrium between the needed health services and limited economic resources. With this limitation in mind, politicians have tried to design health policies that maximise individuals’ welfare. Based on the theory of decentralisation, the devolution of public expenditure decisions and management to regional government maximises individuals’ welfare more when individual preferences differ among regions. A discrete choice experiment was implemented with a survey designed to obtain data about individuals’ choices. Using this data and discrete choice models, individual preferences for health services were estimated. Our findings indicate that these preferences differ among regions, so, for reasons of efficiency, decentralising decisions and management of public health policies to regional governments would be recommended. Once health policies are decentralised, our results provide a tool for identifying the health services most valued by the individuals in each region. This information would be useful policymakers designing health policies.

Youth mental health service preferences and utilization patterns among Latinx caregivers

Latinx caregivers underutilize traditional youth mental health services (MHS) relative to their White counterparts. Disparities may be explained by barriers preventing engagement in traditional MHS. A potential mismatch between available services and preferred culturally appropriate healing practices may also contribute to treatment disparities. The current study examined Latinx caregivers’ perceived need for and utilization of support services in relation to family characteristics, youth problem-type, and barriers to care. Findings were contextualized by assessing caregiver preferences for addressing youth psychopathology. The study consisted of 598 Latinx caregivers from across the United States. Descriptive statistics and binary logistic regression models were used to conduct exploratory analyses. The most frequently used sources of support for youths were medical doctors, school professionals, family or friends, psychological counseling or therapy, and parenting classes. Caregiver perceived need for and utilization of services was generally greater among youths with clinically elevated internalizing or externalizing problems. While Latinx caregivers report needing and utilizing a variety of services to address youth psychopathology, they frequently ranked psychological counseling as their most preferred format. Problem-specific service need and utilization was found for medical (i.e., clinical internalizing problems) and religious services (i.e., minister or faith healer; clinical externalizing problems). Youth and family characteristics and barriers to care were differentially associated with service need and utilization across formats. Our findings suggest a need to increase access to youth psychological counseling services among Latinxs and highlight additional avenues for integrating MHS into formats that caregivers frequently report needing and utilizing.

Mental health service preferences of patients and providers: a scoping review of conjoint analysis and discrete choice experiments from global public health literature over the last 20\u2009years (1999\u20132019)

BackgroundIn designing, adapting, and integrating mental health interventions, it is pertinent to understand patients’ needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers.MethodsWe performed a scoping review from the past 20 years (2009–2019) to identify and describe applications of conjoint analysis and discrete choice experiments. We searched the following electronic databases: Pubmed, CINAHL, PsychInfo, Embase, Cochrane, and Web of Science to identify stakehold,er preferences for mental health services using Mesh terms. Studies were categorized according to pertaining to patients, providers and parents or caregivers.ResultsAmong the 30 studies we reviewed, most were published after 2010 (24/30, 80%), the majority were conducted in the United States (11/30, 37%) or Canada (10/30, 33%), and all were conducted in high-income settings. Studies more frequently elicited preferences from patients or potential patients (21/30, 70%) as opposed to providers. About half of the studies used CA while the others utilized DCEs. Nearly half of the studies sought preferences for mental health services in general (14/30, 47%) while a quarter specifically evaluated preferences for unipolar depression services (8/30, 27%). Most of the studies sought stakeholder preferences for attributes of mental health care and treatment services (17/30, 57%).ConclusionsOverall, preference elicitation approaches have been increasingly applied to mental health services globally in the past 20 years. To date, these methods have been exclusively applied to populations within the field of mental health in high-income countries. Prioritizing patients’ needs and preferences is a vital component of patient-centered care – one of the six domains of health care quality. Identifying patient preferences for mental health services may improve quality of care and, ultimately, increase acceptability and uptake of services among patients. Rigorous preference-elicitation approaches should be considered, especially in settings where mental health resources are scarce, to illuminate resource allocation toward preferred service characteristics especially within low-income settings.

Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers

BackgroundAmyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user.MethodsA DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant’s choice.ResultsPatients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients.ConclusionsThe DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.

Health service preferences among veterans in supported housing in relation to needs expressed and services used

Background Understanding consumer service preferences is important for recovery-oriented care. Aims To test the influence of perceived service needs on importance attached to treatment for alcohol, drug, mental health, and physical health problems and identify the influence of service needs and preferences on service use. Methods Formerly homeless dually diagnosed Veterans in supported housing were surveyed in three waves for 1 year, with measures of treatment interests, health problems, social support, clinician-assessed risk of housing loss, and sociodemographics. Multiple regression analysis was used to identify independent influences on preferences in each wave. Different health services at the VA were distinguished in administrative records and baseline predictors for services used throughout the project were identified with multiple regression analysis. Results Self-assessed problem severity was associated with the importance of treatment for alcohol, drug, mental health, and physical health problems. Social support also had some association with treatment interest for alcohol abuse, as did baseline clinician risk rating at the project’s end. Preferences, but not perceived problem severity, predicted the use of the corresponding health services. Conclusions The health beliefs model of service interests was supported, but more integrated service delivery models may be needed to strengthen the association of health needs with service use.

Experiences of symptoms and health service preferences among older people living with chronic diseases during the last year of life.

There is limited understanding of the symptoms that older people living with cancer, chronic obstructive pulmonary disease and chronic kidney disease experience during the last year of life in Thailand, in addition to their health service preferences. To survey the symptom experiences and health service preferences at the end of life of older people with chronic illnesses from the perspective of bereaved carers. The study used a retrospective post-bereavement approach to collect quantitative data. Purposive sampling was used to select 76 bereaved relatives of older people living with chronic illnesses who had died in the previous 5 to10 months. Telephone interviews and a translated version of the Views of Informal Carers-Evaluation Services (VOICES) questionnaire were conducted. Data were analysed using the statistical package SPSS version 17. The overall quality of care received by older people living with chronic diseases during the last three months of life was described as 'good' (36%). However, in comparing the quality of care from different settings, most of the subjects (63%) thought that the quality of care at home should be rated as 'poor'. During the last twelve months, 35% of the respondents rated pain and poor appetite as the main symptoms, while 25% described experiencing 'worry' related to being at the end of life. The severity of many symptoms increased during the last three months of life; 21% of carers recommended that pain caused the most suffering to their relatives at 'all times', when compared with other symptoms of end of life. Around 21-35% reported that their relatives 'sometimes' experienced worry, low mood, breathlessness and oedema. During the last three days of life, it was reported by 97% of respondents that their relatives spent all of their time in hospital, and no respondents reported that their relatives had died at home. The study indicates that older people living with chronic diseases in Thailand are less likely to access specialist palliative care and are more likely to have poor symptom control at the end of life. It indicates that health services may not be meeting patients' needs and that there was clearly insufficient healthcare provision at home for older people to help them to manage their symptoms such as pain and breathlessness.

Mental Health Service Preferences and Utilization Among Women Veterans in Crisis: Perspectives of Veterans Crisis Line Responders.

Women military veterans are at increased risk of suicide compared to non-veterans, but little is known about the mental health service preferences and needs of women veterans in crisis. This study used qualitative, secondary source key informant interviews to ascertain the experiences of women veterans in crisis from 54 responders working at the Veterans Crisis Line. Responders indicated that women veterans reported different experiences with Veterans Administration (VA) and non-VA care, though drivers of satisfaction or dissatisfaction were similar. Availability of specialty care, sensitivity to veterans' issues or Military Sexual Trauma, strong provider relationships, and continuity of care contributed to satisfaction; lengthy appointment wait times, limited service options, and insensitivity to veterans' issues contributed to dissatisfaction. Responders suggested that barriers limiting VA access for women veterans are perceived as similar to non-VA care. Findings suggest that caller experiences with providers drive satisfaction with VA and non-VA mental health services.

Does the use of the proportional shortfall help align the prioritisation of health services with public preferences?

It has been proposed that equity may be included in the economic evaluation of health services using the 'proportional shortfall' (PS)-the proportion of a person's QALY expectation that they would lose because of an illness. The present paper reports the results of a population survey designed to test whether PS helped to explain people's preferences for health services and whether it did this better than the absolute shortfall or the equity related variables that PS seeks to replace. Survey respondents were asked to allocate 100 votes between 13 scenarios and a standard scenario. Variation in the allocation of votes was explained by health gain and different combinations of the equity variables. Differences in votes for the comparisons were significantly related to differences in PS but the relationship was weaker than between votes and the age related variables. Cases were identified where PS suggested a priority ordering of services which was strongly rejected by respondents. It is concluded that the use of PS is unlikely to improve the alignment of priorities with public preferences.

Abstract B53: A case study on differences on cervical cancer screening knowledge and prevention practices among Latinas at two sites in a community-based participatory randomized control trial in South Florida

Abstract Immigrant Latinas are less likely to be screened for cervical cancer. With National Cancer Institute (NCI) support, we are examining the effectiveness of community health workers (CHWs) at increasing cervical cancer screening using self-sampling for the Human Papilloma virus (HPV, done free) versus clinic referral for traditional Pap Smear screening (nominal co-payments). Out of 455 participants enrolled to date, one site (Hialeah) serves mostly Cuban women (N=152) and the other site (Southern Miami-Dade County, SMD) serves a predominantly non-Cuban Latino population (N=112 plus 39 non Hispanic). Using a mixed methods quantitative/qualitative approach, we examined differences in demographics, cervical cancer knowledge and prevention practices among participants at these sites. Latino participants in Hialeah were younger, more recent immigrants, more educated, insured, higher literacy (SAHLSA), and higher cervical cancer knowledge that those in SMD. Most participants in Hialeah (95%) preferred HPV self-sampling citing familiarity with home based vaginal screening in Cuba and preferences for health services that were free as main reason for choosing HPV self-sampling. In SMD only half the population chose the HPV self-sampler. Cultural discomfort with vaginal self-sampling, preference for a doctor to perform a vaginal exam, and greater willingness to pay for health care services (despite lower SES) were found be major reasons why many women in SMD preferred being referred to a clinic for a traditional Pap smear. This study again highlights major differences in health knowledge and behaviors among different Latino subgroups. It also emphasizes the need for community based health programs to be tailored to the specific needs and practices of distinct Latino communities. Citation Format: Brendaly Rodriguez, Olveen Carrasquillo, Erin Kobetz, Martha Gonzalez, Tulay Koru-Sengal, Feng Miao, Shelia McCann, Anthony Amofah, Brigitte Frett. A case study on differences on cervical cancer screening knowledge and prevention practices among Latinas at two sites in a community-based participatory randomized control trial in South Florida. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B53. doi:10.1158/1538-7755.DISP13-B53

Exploring e-Mental Health Preferences of Generation Y

E-Mental Health services could substantially increase the capacity of the mental health care system. This article explores youth consumer preferences for online interventions targeting depression and anxiety. Twenty-three participants who had experienced suicidal ideation and either depression or anxiety and completed one qualitative interview were included. Interviews were topically guided to cover themes of e-Mental Health service preferences around online help-seeking behavior, appearance, content, privacy, and support. We found that youth positively received the idea of, and appreciated the need for, e-Mental Health services. Noted preferences for services were those that are simple to use, interactive, and include support through an online community.

Getting the Water Prices Right Using an Incentive-based Approach: An Application of a Choice Experiment in Khorezm, Uzbekistan

This article explores whether water pricing can be implemented by the bundling of water services with additional non-water-related community services in order to increase farmers’ willingness to pay (WTP) for water. Using a choice experiment in the Khorezm region of Uzbekistan, we examine whether part of the water fees that are collected by a Water User Association could be used to provide socio-economic benefits to its members. This could then motivate users to pay higher water fees. Such services include provision of microcredit, maintenance of health centers and schools, and community training programs, in addition to maintenance of irrigation infrastructure and drainage systems. The results indicate that bundling different services yielding individual and communal benefits, respectively, can increase the farmer’s WTP for water compared with the scenarios without bundling. Our results also identify heterogeneous preferences among farmers: rice farmers are likely to pay more for water in general, whereas farmers earning less income have a stronger preference for health services.

Exploration of health status, healthcare utilization, and health service expectations among Taiwanese adolescents

There have been few reports about adolescent experiences with and expectations of health service utilization in an Asian societal setting. The aim of this study is to analyze the use of healthcare services in relation to health status and explore adolescents' preferences for youth-friendly service among Taiwanese high school students. A cross-sectional questionnaire-based survey was conducted on Taiwanese adolescents aged 12–18 years in 2010.We invited participants to rate their health status, report their previous healthcare service use, and rank their health service preferences.We used logistic regression analysis to investigate the association between self-rated health status and healthcare utilization and used nonparametric analysis to compare health service preferences among sociodemographic subgroups. A total of 4,907 students (97.2 % response rate) returned valid questionnaires for analysis. Poor health status and chronic illness were most salient factors independently associated with frequent healthcare service use. Only 40 % of respondents reported having a regular doctor, and pediatrics (57.7 %) was the most commonly identified professional source of medical care. A great majority (86.2 %) of respondents made clinical visits with parents. For characteristics of youth-friendly clinician, the top-ranked items included competency and patience, while having helpful and friendly personnel was highlighted for clinical setting. Family participation is critical in healthcare for adolescents in Asian cultures. Health service use is significantly influenced by health status and chronic illness in the general health insurance system. Understanding these background influences on expectations for healthcare may help to create youth-friendly health services that are more culturally appropriate.

Is Consulting Patients About Their Health Service Preferences a Useful Exercise?

As part of the shift toward patient-centered care, patients are increasingly being consulted about their preferences for health services and interventions, including those explored during randomized controlled trials (RCTs), to ensure that service recommendations are aligned to their own circumstances and needs. Hence, we interviewed patients (N = 40) who participated in a randomized control trial comparing diabetes education courses delivered using two different formats to establish whether, and why, they preferred one format to the other, to inform recommendations for future course delivery. Not only did patients report changing their preferences, and the reasons underlying these preferences, over time, but all patients also claimed to prefer the particular course they had attended. We use our findings and experiences to problematize the notion of a patient preference and to raise questions about what we can really learn from consulting patients about the care they receive within the context of an RCT.

Intergovernmental Responsibility for Social Policy: An Analysis of Public Preferences in Spain

Although a considerable amount is known about public preferences for multilevel government in the United States, there is less empirical evidence for other types of federations. Moreover, prior studies have neglected regional differences in intergovernmental policy preferences, despite the relevance of regional variation in places where territorial claims for autonomy exist. This article analyzes citizen preferences for the assignment of responsibility for social policies in Spain. Using data from a survey conducted in 2005 (prior to the European economic crisis), we find distinct patterns across regions in the strength of assignment preferences for health services, pensions, education, and social services. We also find that education, age, gender, social class, political ideology, preferences for lower taxes, and regional political identity are also independent determinants of assignment preferences.