Eliciting reasons: empirical methods in priority setting

Job preferences of master of public health students in China: a discrete choice experiment

BACKGROUND

The shortage of public health personnel and the uneven distribution between urban and rural areas are thorny issues in China. Master of public health (MPH) is an integral part of public health human resources in the future, and it is of far-reaching significance to discuss their work preferences. The present study wants to investigate the job preference of MPH, understand the relative importance of different job attributes, and then put forward targeted incentive measures.

METHODS

Discrete choice experiment (DCE) was used to evaluate the job preference of MPHs in two medical colleges in Liaoning Province. Attributes include employment location, bianzhi, working environment, career development prospects, work value and monthly income. Thirty-six choice sets were developed using a fractional factorial design. Mixed logit models were used to analysis the DCE data.

RESULTS

The final sample comprised 327 MPHs. All the attributes and levels included in the study are statistically significant. Monthly income is the most important factor for MPHs. For non-economic factors, they value career development prospects most, followed by the employment location. Respondents' preferences are heterogeneous and influenced by individual characteristics. Subgroup analysis showed that respondents from different family backgrounds have different job preferences. Policy simulation suggested that respondents were most sensitive to a salary increase, and the combination of several non-economic factors can also achieve the same effect.

CONCLUSIONS

Economic factors and non-economic factors significantly affect the job preference of MPHs. To alleviate the shortage and uneven distribution of public health personnel, more effective policy intervention should comprehensively consider the incentive measures of the work itself and pay attention to the individual characteristics and family backgrounds of the target object.

Healthcare resource allocation decisions affecting uninsured services

Purpose Using the example of community access programs (CAPs), the purpose of this paper is to describe resource allocation and policy decisions related to providing health services for the uninsured in the USA and the organizational values affecting these decisions. Design/methodology/approach The study used comparative case study methodology at two geographically diverse sites. Researchers collected data from program documents, meeting observations, and interviews with program stakeholders. Findings Five resource allocation or policy decisions relevant to providing healthcare services were described at each site across three categories: designing the health plan, reacting to funding changes, and revising policies. Organizational values of access to care and stewardship most frequently affected resource allocation and policy decisions, while economic and political pressures affect the relative prioritization of values. Research limitations/implications Small sample size, the potential for social desirability or recall bias, and the exclusion of provider, member or community perspectives beyond those represented among participating board members. Practical implications Program directors or researchers can use this study to assess the extent to which resource allocation and policy decisions align with organizational values and mission statements. Social implications The description of how healthcare decisions are actually made can be matched with literature that describes how healthcare resource decisions ought to be made, in order to provide a normative grounding for future decisions. Originality/value This study addresses a gap in literature regarding how CAPs actually make resource allocation decisions that affect access to healthcare services.

Hospital preferences of nursing students in Korea: a discrete choice experiment approach

BACKGROUND

DCE was applied to investigate nursing students' preferred hospital choice criteria and to investigate the trends in the trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of the hospitals primarily selected by nursing students, and aims to estimate the monetary value of each attribute.

METHODS

Based on discussions and in-depth interviews with nursing students' focus groups and a literature review, we created a discrete choice experiment (DCE) that assessed how students' stated preference for a certain hospital choice was influenced by various job attributes: higher salary, location, hospital type, salary per year, provision of a dormitory, etc. We applied this DCE to nursing students in South Korea using a brief structured questionnaire, and we used conditional logit models to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative of the cost attribute.

RESULTS

Complete data for the DCE analysis were available for 702 nursing students. In the main effect mixed logit model, the welfare system and organizational culture were most strongly associated with job preference. Location, hospital type, and opportunity to upgrade qualifications had a negative influence on hospital choice. The WTP threshold was 7,043,000 KRW for the welfare system and 9,928,000 KRW for the organizational culture (relation-oriented).

CONCLUSIONS

Better nursing working conditions, such as a positive organizational culture and the provision of a welfare system, can improve the motivation and applications for hospitals in rural areas.

Priority setting in Indigenous health: assessing priority setting process and criteria that should guide the health system to improve Indigenous Australian health

INTRODUCTION

The health of Indigenous Australians is worse than that of other Australians. Most of the determinants of health are preventable and the poor health outcomes are inequitable. The Australian Government recently pledged to close that health gap. One possible way is to improve the priority setting process to ensure transparency and the use of evidence such as epidemiology, equity and economic evaluation.The purpose of this research was to elicit the perceptions of Indigenous and non-Indigenous decision-makers on several issues related to priority setting in Indigenous-specific health care services. Specifically, we aimed to:1. identify the criteria used to set priorities in Indigenous-specific health care services;2. determine the level of uptake of economic evaluation evidence by decision-makers and how to improve its uptake; and 3. identify how the priority setting process can be improved from the perspective of decision-makers.

METHODS

We used a paper survey instrument, adapted from Mitton and colleagues' work, and a face-to-face interview approach to elicit decision-makers' perceptions in Indigenous-specific health care in Victoria, Australia. We used mixed methods to analyse data from the survey. Responses were summarised using descriptive statistics and content analysis. Results were reported as numbers and percentages.

RESULTS

The size of the health burden; sustainability and acceptability of interventions; historical trends/patterns; and efficiency are key criteria for making choices in Indigenous health in Victoria. There is a need for an explicit priority setting approach, which is systematic, and is able to use available data/evidence, such as economic evaluation evidence. The involvement of Indigenous Australians in the process would potentially make the process acceptable.

CONCLUSIONS

An economic approach to priority setting is a potentially acceptable and useful tool for Aboriginal Community Controlled Health Services (ACCHS). It has the ability to use evidence and ensure due process at the same time. The use of evidence can ensure that health outcomes for Indigenous peoples can be maximised - hence, increase the potential for 'closing the gap' between Indigenous and other Australians.

Eliciting public preference for health-care resource allocation in South Korea

OBJECTIVES

To identify the principles the public considers important and the trade-offs between different values in health-care resource allocation practices.

METHODS

This study approached the issue in both qualitative and quantitative ways. In a qualitative study, two focus groups discussed the issues of resource allocation in health care. To facilitate the discussion, a simple ranking task and a series of pairwise choice practices were implemented. A discrete choice experiment survey questionnaire was also administered to a sample of the general population. Attributes and levels were determined through literature reviews and the results from the focus group interview. We used a random-effect probit model to assess the effects of each attribute.

RESULTS

Through the focus group interviews, we found strong public support for the principle of equal opportunity. The participants thought that the severity of disease was the most important criterion when setting priorities. The majority supported the idea that the most disadvantaged should have the highest priority even when their health gains are less than those of others. The discrete choice experiment results showed that the severity of disease, health gains, and patients' socioeconomic status significantly influence their choices, with each parameter having an expected sign.

CONCLUSION

The results showed that Koreans support not only health maximization but also equal opportunity, fair resource allocation, and equality.

Mapping the integration of social and ethical issues in health technology assessment

Background:Since its inception, the field of health technology assessment (HTA) has stressed the need for consideration of ethical and social issues. However, few concepts or analytic tools have been developed, and because of the complexity of the endeavor and a lack of integration of work already produced, such concepts remain difficult to apply in HTA.

Objectives:Through a descriptive “map” of concepts, tools, and processes, we summarize the most tangible efforts on the part of HTA producers to address social and ethical issues.

Methods:A literature review and content analysis of HTA reports in the Centre for Reviews and Dissemination database enables a synthesis of the reflections on, initiatives around, and gaps in knowledge related to the integration of social and ethical issues in HTA.

Results:We examine: (i) the aim of integrating ethical and social issues in HTA, (ii) the theoretical approaches used, (iii) the methods and processes applied, and (iv) the implications for HTA producers. We highlight two levels at which social and ethical issues can be considered: throughout the production process of HTA reports and as part of the organizational structure of HTA agencies.

Conclusions:Given the profound societal changes that occur in relation to healthcare technology development, HTA producers have a responsibility to inform and enlighten technology-related public and policy debates. Fulfilling this role, though, requires that socioethical dimensions of technologyandHTA are made explicit.