Health System Choice: a pilot discrete-choice experiment eliciting the preferences of British and Australian citizens

Abstract

Citizen preferences surrounding desirable health system characteristics should be considered when undertaking health system reform. The objective of this study was to pilot test a discrete-choice instrument designed to elicit preference weights surrounding health system attributes. A discrete-choice experiment was designed and administered to two convenience samples (n = 50 each) recruited from the UK and Australia. The impact of eight health system attributes representing level of health, equity, responsiveness and healthcare financing on the choice between hypothetical health systems was analysed utilizing mixed logit analysis. All characteristics affected the likelihood a health system would be preferred, with the exception of the additional tax contribution levels required to finance the system. There were very few missing or inconsistent responses. The direction of preferences was consistent with expectations for both samples; that is, an improvement in attributes describing level of health, equity or responsiveness increased the likelihood that a health system would be preferred. A number of potential improvements to the preference instrument are suggested. The discrete-choice technique used in this study offers a feasible method for eliciting health system preferences, and its use in a larger-scale study to elicit and compare the preferences of representative population samples is supported.