Attribute development and level selection for a discrete choice experiment to elicit the preferences of health care providers for capitation payment mechanism in Kenya

Abstract

BackgroundStated preference elicitation methods such as discrete choice experiments (DCEs) are now widely used in the health domain. However, the “quality” of health-related DCEs has come under criticism due to the lack of rigour in conducting and reporting some aspects of the design process such as attribute and level development. Superficially selecting attributes and levels and vaguely reporting the process might result in misspecification of attributes which may, in turn, bias the study and misinform policy. To address these concerns, we meticulously conducted and report our systematic attribute development and level selection process for a DCE to elicit the preferences of health care providers for the attributes of a capitation payment mechanism in Kenya.MethodologyWe used a four-stage process proposed by Helter and Boehler to conduct and report the attribute development and level selection process. The process entailed raw data collection, data reduction, removing inappropriate attributes, and wording of attributes. Raw data was collected through a literature review and a qualitative study. Data was reduced to a long list of attributes which were then screened for appropriateness by a panel of experts. The resulting attributes and levels were worded and pretested in a pilot study. Revisions were made and a final list of attributes and levels decided.ResultsThe literature review unearthed seven attributes of provider payment mechanisms while the qualitative study uncovered 10 capitation attributes. Then, inappropriate attributes were removed using criteria such as salience, correlation, plausibility, and capability of being traded. The resulting five attributes were worded appropriately and pretested in a pilot study with 31 respondents. The pilot study results were used to make revisions. Finally, four attributes were established for the DCE, namely, payment schedule, timeliness of payments, capitation rate per individual per year, and services to be paid by the capitation rate.ConclusionBy rigorously conducting and reporting the process of attribute development and level selection of our DCE,we improved transparency and helped researchers judge the quality.

Preferences of healthcare providers for capitation payment in Kenya: a discrete choice experiment

“…In the fourth stage, three researchers deliberated and agreed on an interim list of five attributes and levels. These were tested in a pilot study with 31 senior health facility managers ( Obadha et al , 2019b ). Then, six researchers reviewed the pilot study results and agreed on a final list of four attributes ( Table 2 ), namely, payment schedule, timeliness of payments, capitation rate per individual per year and services to be paid by the capitation rate.…”

“…Then, six researchers reviewed the pilot study results and agreed on a final list of four attributes ( Table 2 ), namely, payment schedule, timeliness of payments, capitation rate per individual per year and services to be paid by the capitation rate. We comprehensively described our attribute development and level selection process in an earlier publication ( Obadha et al , 2019a ).…”

“…Twelve choice sets were deemed optimal for the main survey as respondents easily handled eight during the pilot study ( Obadha et al , 2019a ). Too many choice sets increase complexity and place a cognitive burden on the respondents, thereby negatively affecting the response reliability ( Bridges et al , 2011 ).…”

“…Bayesian priors were obtained from a pilot study ( Obadha et al , 2019b ). In the utility function, we specified a main effects model optimizing for a multinomial logit and evaluating for a panel mixed multinomial logit (MMNL) model.…”

“…Finally, the sixth section collected supplementary information. The questionnaire had been pretested in a pilot study and revisions made ( Obadha et al , 2019a ).…”