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Preferences for hospital quality in Zambia: results from a discrete choice experiment

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Author Info

  • Kara Hanson

    (Health Policy Unit, London School of Hygiene and Tropical Medicine, UK)

  • Barbara McPake

    (Health Policy Unit, London School of Hygiene and Tropical Medicine, UK)

  • Pamela Nakamba

    (Department of Economics, University of Zambia, Zambia)

  • Luke Archard

    (Health Policy Unit, London School of Hygiene and Tropical Medicine, UK)

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    Abstract

    This study reports on the results of a discrete choice experiment undertaken in Zambia to assess the factors influencing the demand for hospital care in Zambia, in particular the role of (perceived) quality and trade-offs between price and quality. Valuations of quality were evaluated for the treatment of two acute medical conditions, cerebral malaria in adults and acute pneumonia in children. Marginal utilities and willingness-to-pay for attributes of quality of hospital care were estimated, together with the influence of socioeconomic characteristics on these valuations and the extent of non-linearities in valuations of time and money. We find the technical quality of care, as represented by the thoroughness of examination, to be the most important quality attribute, followed by staff attitudes and drug availability. Valuations of examination thoroughness increase with increasing socioeconomic status. The disutility of cost was found to decrease with higher socioeconomic status, as was the value of drug availability. The implications of the findings for Zambian hospital sector reforms are discussed. Copyright © 2004 John Wiley & Sons, Ltd.

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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 14 (2005)
    Issue (Month): 7 ()
    Pages: 687-701

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    Handle: RePEc:wly:hlthec:v:14:y:2005:i:7:p:687-701

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. McPake, Barbara Isobel, 1996. "Public autonomous hospitals in sub-Saharan Africa: trends and issues," Health Policy, Elsevier, Elsevier, vol. 35(2), pages 155-177, February.
    2. Mandy Ryan & Jenny Hughes, 1997. "Using Conjoint Analysis to Assess Women's Preferences for Miscarriage Management," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 6(3), pages 261-273.
    3. Filmer, Deon & Pritchett, Lant, 1998. "Estimating wealth effects without expenditure data - or tears : with an application to educational enrollments in states of India," Policy Research Working Paper Series 1994, The World Bank.
    4. Scott, Anthony & Watson, M. Stuart & Ross, Sue, 2003. "Eliciting preferences of the community for out of hours care provided by general practitioners: a stated preference discrete choice experiment," Social Science & Medicine, Elsevier, Elsevier, vol. 56(4), pages 803-814, February.
    5. G. Salkeld & M. Ryan & L. Short, 2000. "The veil of experience: do consumers prefer what they know best?," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 9(3), pages 267-270.
    6. Scott, Anthony, 2001. "Eliciting GPs' preferences for pecuniary and non-pecuniary job characteristics," Journal of Health Economics, Elsevier, Elsevier, vol. 20(3), pages 329-347, May.
    7. Stirling Bryan & Martin Buxton & Robert Sheldon & Alison Grant, 1998. "Magnetic resonance imaging for the investigation of knee injuries: an investigation of preferences," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 7(7), pages 595-603.
    8. van der Pol, Marjon & Cairns, John, 2001. "Estimating time preferences for health using discrete choice experiments," Social Science & Medicine, Elsevier, Elsevier, vol. 52(9), pages 1459-1470, May.
    9. F. Reed Johnson & Melissa Ruby Banzhaf & William H. Desvousges, 2000. "Willingness to pay for improved respiratory and cardiovascular health: a multiple-format, stated-preference approach," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 9(4), pages 295-317.
    10. Shelley Farrar & Mandy Ryan, 1999. "Response-ordering effects: a methodological issue in conjoint analysis," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 8(1), pages 75-79.
    11. Harry Telser & Peter Zweifel, 2002. "Measuring willingness-to-pay for risk reduction: an application of conjoint analysis," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 11(2), pages 129-139.
    12. Zafar Hakim & Dev S. Pathak, 1999. "Modelling the EuroQol data: a comparison of discrete choice conjoint and conditional preference modelling," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 8(2), pages 103-116.
    13. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 9(2), pages 137-148.
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    Cited by:
    1. Shomikho Raha & Peter Berman & Aarushi Bhatnagar, 2009. "Career Preferences of Medical and Nursing Students in Uttar Pradesh," World Bank Other Operational Studies 12836, The World Bank.
    2. Bart Neuts & Peter Nijkamp & Eveline van Leeuwen, 2013. "Crowding Externalities from Tourist Use of Urban Space," Tinbergen Institute Discussion Papers, Tinbergen Institute 13-146/VIII, Tinbergen Institute.
    3. Arne Risa Hole, 2007. "Modelling Heterogeneity in Patients' Preferences for the Attributes of a General Practitioner Appointment," Working Papers, Centre for Health Economics, University of York 022cherp, Centre for Health Economics, University of York.
    4. Kruk, Margaret E. & Rockers, Peter C. & Mbaruku, Godfrey & Paczkowski, Magdalena M. & Galea, Sandro, 2010. "Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis," Health Policy, Elsevier, Elsevier, vol. 97(2-3), pages 209-216, October.
    5. Van Rijsbergen, Bart & D’Exelle, Ben, 2013. "Delivery Care in Tanzania: A Comparative Analysis of Use and Preferences," World Development, Elsevier, Elsevier, vol. 43(C), pages 276-287.

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