Effect of hospital attributes on patient preference among outpatient attendants in Wolaita Zone, Southern Ethiopia: discrete choice experiment study

Abstract

Background Patient preference has preceded the use of health care services, and it has been affected by different hospital attributes. Meanwhile, the number of patients receiving vital health intervention is particularly low in Ethiopia. Therefore, this study aimed to determine the effect of hospital attributes on patient preference for outpatients in the Wolaita area in September 2020. Methods A discrete choice experimental study was applied to determine the effect of hospital attributes on patient preference with a sample size of 1077. The experimental survey was conducted among outpatient attendants selected through a systematic random sampling approach. Six key attributes (competence of healthcare providers; availability of medical equipment and supplies; cost of service; wait time; distance; and hospital reputation) deduced from various hospital attributes were used to elicit the patient preferences. The data was collected from participants through the Open Data Kit application. A random effect probit model with marginal willingness to pay measure and partially log-likelihood analysis was applied to extract important attributes. We used STATA version 15 software for analysis, and the fitness of the model was verified by the calculated p-value for the Wald chi-square with a cut-point value of 0.05. Result One thousand forty-five patients who received outpatient care participated in the study. The random effect probit results have shown that all hospital attributes included in the study were significantly valued by patients while choosing the hospital (p-value < 0.001). Meanwhile, based on marginal willingness to pay and partial log-likelihood analysis, the competence of health care providers was identified as the most important attribute followed by the availability of medical equipment and supplies in hospitals. Conclusion and recommendation The results suggested that the quality of health care providers and availability of medical equipment and supply in hospitals would be primary interventional points for improving the patient preference of hospitals. Assessment, education, and training are recommended for enhancing the quality of health care providers. And stock balance checks, inspections, and accreditation are believed to be valuable for improving the availability of equipment and supply in hospitals.

What do Iranians value most when choosing a hospital? Evidence from a discrete choice experiment

“…Our work shows that these factors are highly valued by people. This result was consistent with previous studies (4, 14–16, 18, 21, 22, 26, 48, 53, 69, 70). Of course, at the same time, we should also pay attention to the fact that some studies have shown that the competition of hospitals to use advanced facilities does not necessarily lead to an improvement in the quality of services or health outcomes (15, 71–73).…”

“…Our study also pointed out the important role of provider competence and indicated that it played an important role in an individual’s choice preferences after hospital facilities. Previous studies also reported the significant role of “provider’s competency and skill” in choosing a hospital, and their result were consistent with the present study (14–16, 22, 29). The provider’s competency depends on the knowledge, expertise, and skill of human resources of any organization.…”

“…These results reflected the important role of advanced technology and facilities in the selection of hospitals (14). The availability of medicine, facilities, and technology is vital for providing high-quality care and people expect high-quality services with advanced hospital facilities (22). Our work shows that these factors are highly valued by people.…”

“…We followed recommended guidelines for the development of attributes through a multi-stage process involving a literature review, qualitative interviews with our target population, Focus Group Discussion (FGD) and stakeholder consultation (13, 15, 22, 30, 35, 36, 41–43, 48, 53, 54, 56–59, 60–62). We created an initial list of attributes and their levels using a literature review including articles, documents, and government reports.…”

“…The way such choices are made and the factors driving them have attracted many researchers. Previous studies indicated that the choice of hospitals is affected by several factors, such as personal preferences and interests (13, 15), service cost (3, 16–22), type and severity of the disease (13, 14, 18, 23–26), waiting time to receive services (22, 27), location and distance between the place of residence and the hospital (3, 9, 13, 16–20, 22, 28–31), availability of advanced medical equipment and technology (3, 13, 22–25, 29, 32), having health insurance (16, 23–25), interpersonal skills, and employees’ behavior (3, 16, 28, 33–35), physician’s expertise (16, 27, 29), hospital reputation (3, 16, 17, 22, 28, 34), service quality (3, 18, 20, 34–36), diversity and method of service provision (3, 16, 21), and patient’s economic capacity (13, 18, 23–26, 37). Several studies indicate that most people tend to choose qualified physicians and hospitals with a high reputation, regardless of the type and severity of their diseases in a context where citizens have full freedom (13).…”