View More View Less
  • 1 Corvinus University of Budapest Health Economics and Health Technology Assessment Research Centre Budapest Hungary
  • | 2 Center for Public Affairs Studies Foundation Budapest Hungary
  • | 3 Maastricht University Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences Maastricht The Netherlands
  • | 4 Maastricht University Topinstitute Evidence-Based Education Research (TIER) Maastricht The Netherlands
Restricted access

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.

  • Acharya, L. B. — Cleland, J. (2000): Maternal and Child Health Services in Rural Nepal: Does Access or Quality Matter More? Health Policy and Planning 15: 223–229.

    Cleland J. , 'Maternal and Child Health Services in Rural Nepal: Does Access or Quality Matter More? ' (2000 ) 15 Health Policy and Planning : 223 -229.

    • Search Google Scholar
  • Addelman, S. (1962): Orthogonal Main-effect Plans for Asymmetrical Factorial Experiments. Technometrics 4: 21–46.

    Addelman S. , 'Orthogonal Main-effect Plans for Asymmetrical Factorial Experiments ' (1962 ) 4 Technometrics : 21 -46.

    • Search Google Scholar
  • Atella, V. — Peracchi, F. — Depalo, D. — Rossetti, C. (2008): Drug Compliance, Co-payment and Health Outcomes: Evidence from a Panel of Italian Patients. CEIS Working Paper No. 76. Accessed at: http://ssrn.com/abstract=871395

  • Austvoll-Dahlgren, A. — Aaserud, M. — Vist, G. — Ramsay, C. — Oxman, A. D. — Sturm, H. — Kösters, J. P. — Vernby, A. (2008): Pharmaceutical Policies: Effects of Cap and Co-payment on Rational Drug Use. Cochrane Database of Systematic Reviews 23(1): CD007017.

    Vernby A. , 'Pharmaceutical Policies: Effects of Cap and Co-payment on Rational Drug Use ' (2008 ) 23 Cochrane Database of Systematic Reviews : CD007017 -.

    • Search Google Scholar
  • Baji, P. — Gulácsi, L. (2010): “Beteg önrész” — a lakosság fizetési hajlandósága az egészségügyi szolgáltatásokért [Patient Payments — Willingness of the Hungarian Population to Pay for Health Care Services]. Esély 4: 106–117.

    Gulácsi L. , '“Beteg önrész” ' (2010 ) 4 Esély : 106 -117.

  • Baji, P. — Pavlova, M. — Gulácsi, L. — Groot, W. (2011a): User Fees for Public Health Care Services in Hungary: Expectations, Experience, and Acceptability from the Perspectives of Different Stakeholders. Health Policy 102(2–3): 255–262.

    Groot W. , 'User Fees for Public Health Care Services in Hungary: Expectations, Experience, and Acceptability from the Perspectives of Different Stakeholders ' (2011 ) 102 Health Policy : 255 -262.

    • Search Google Scholar
  • Baji, P. — Pavlova, M. — Gulácsi, L. — Homolyáné Csete, Zs. — Groot, W. (2011b): Informal Payments for Health Care Services and Short-Term Effects of the Introduction of Visit Fee on These Payments in Hungary. International Journal of Health Planning and Management. (forthcoming, doi: 10.1002/hpm.1106).

  • Becker, G. S. (1967): Human Capital and the Personal Distribution of Income: An Analytical Approach. Michigan: University of Michigan, Institute of Public Administration.

    Becker G. S. , '', in Human Capital and the Personal Distribution of Income: An Analytical Approach , (1967 ) -.

  • Belicza, É. (2006): Egyenlõtlenségek a szolgáltatások igénybevétele során a járóbeteg szakellátásban [Inequalities in the Use of Out-patient Health Care Services]. Informatika és Menedzsment az Egészségügyben (IME) 4(10): 9–15.

    Belicza , 'Egyenlõtlenségek a szolgáltatások igénybevétele során a járóbeteg szakellátásban ' (2006 ) 4 Informatika és Menedzsment az Egészségügyben (IME) : 9 -15.

    • Search Google Scholar
  • Berki, S. E. — Ashcraft, M. L. (1980):HMOEnrollment: Who Joins What and Why: AReview of the Literature. The Milbank Memorial Fund Quarterly. Health and Society 58(4): 588–632.

    Ashcraft M. L. , 'HMOEnrollment: Who Joins What and Why: AReview of the Literature ' (1980 ) 58 The Milbank Memorial Fund Quarterly. Health and Society : 588 -632.

    • Search Google Scholar
  • Boncz, I. — Gulácsi, L. — Kovács, E. — Oesterle, A. (2007): Verseny az egészségügyben. Egyesült államokbeli és nyugat-európai példák [Competition on the Market of Health Care. Examples of the USA and Western Europe]. Közgazdasági Szemle 54: 480–498.

    Oesterle A. , 'Verseny az egészségügyben. Egyesült államokbeli és nyugat-európai példák ' (2007 ) 54 Közgazdasági Szemle : 480 -498.

    • Search Google Scholar
  • Donabedian, A. (1966): Evaluating the Quality of Medical Care. Millbank Memorial Fund Quarterly 44(2): 166–206.

    Donabedian A. , 'Evaluating the Quality of Medical Care ' (1966 ) 44 Millbank Memorial Fund Quarterly : 166 -206.

    • Search Google Scholar
  • Donabedian, A. (1982): Explorations in Quality Assessment and Monitoring. Vol. 2. The Criteria and Standards of Quality. Ann Arbor, MI: Health Administration Press.

    Donabedian A. , '', in Explorations in Quality Assessment and Monitoring. Vol. 2. The Criteria and Standards of Quality , (1982 ) -.

  • Donabedian, A. (1988): The Assessment of Technology and Quality. International Journal of Technology Assessment in Health Care 4: 487–496.

    Donabedian A. , 'The Assessment of Technology and Quality ' (1988 ) 4 International Journal of Technology Assessment in Health Care : 487 -496.

    • Search Google Scholar
  • Dózsa, C. — Dérer, I. — Boncz, I. — Takács, E. (2006): Az OEP szolgáltatásvásárlói és biztosítói szerepének erõsítése, mint a magyar egészségügyi rendszer reformjának egyik fontos eszköze: 2. [Enhancing the Purchaser Role of the National Health Insurance Fund is One Important Elements of the Health Care Reforms. Part 2]. Informatika és Menedzsment az Egészségügyben (IME) 5(8): 5–16.

    Takács E. , 'Az OEP szolgáltatásvásárlói és biztosítói szerepének erõsítése, mint a magyar egészségügyi rendszer reformjának egyik fontos eszköze: 2 ' (2006 ) 5 Informatika és Menedzsment az Egészségügyben (IME) : 5 -16.

    • Search Google Scholar
  • Gaál, P. — Evetovits, T. — McKee, M. (2006): Informal Payment for Health Care: Evidence from Hungary. Health Policy 77(1): 86–102.

    McKee M. , 'Informal Payment for Health Care: Evidence from Hungary ' (2006 ) 77 Health Policy : 86 -102.

    • Search Google Scholar
  • Gaál, P. — Szigeti, Sz. — Panteli, D. — Gaskins, M. — van Ginneken, E. (2011): Major Challenges Ahead for Hungarian Healthcare. British Medical Journal Dec 7 343: d7657.

    Ginneken E. , 'Major Challenges Ahead for Hungarian Healthcare ' (2011 ) 343 British Medical Journal : d7657 -.

    • Search Google Scholar
  • Gaziano, C. (2005): Comparative Analysis of Within-household Respondent Selection Techniques. Public Opinion Quarterly 69(1): 124–157.

    Gaziano C. , 'Comparative Analysis of Within-household Respondent Selection Techniques ' (2005 ) 69 Public Opinion Quarterly : 124 -157.

    • Search Google Scholar
  • Hanley, N. — Ryan, M. — Wright, R. (2003): Estimating the Monetary Value of Health Care: Lessons from Environmental Economics. Health Economics 12: 3–16.

    Wright R. , 'Estimating the Monetary Value of Health Care: Lessons from Environmental Economics ' (2003 ) 12 Health Economics : 3 -16.

    • Search Google Scholar
  • Harris, K. M. (2002) Can High Quality Overcome Consumer Resistance to Restricted Provider Access? Evidence from a Health Plan Choice Experiment. Health Service Research 37: 551–571.

    Harris K. M. , 'Can High Quality Overcome Consumer Resistance to Restricted Provider Access? Evidence from a Health Plan Choice Experiment ' (2002 ) 37 Health Service Research : 551 -571.

    • Search Google Scholar
  • Lancsar, E. — Louviere, J. (2008): Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: A User’s Guide. Pharmacoeconomics 26(8): 661–677.

    Louviere J. , 'Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: A User’s Guide ' (2008 ) 26 Pharmacoeconomics : 661 -677.

    • Search Google Scholar
  • Merino-Castello, A. (2003): Eliciting Consumers Preferences Using Stated Preference Discrete Choice Models: Contingent Ranking versus Choice Experiment. UPF Working Paper No. 705.

  • Mincer, J. — Polachek, S. (1974): Family Investment in Human Capital: Earnings of Woman. Journal of Political Economy 82(2): S76–S108.

    Polachek S. , 'Family Investment in Human Capital: Earnings of Woman ' (1974 ) 82 Journal of Political Economy : S76 -S108.

    • Search Google Scholar
  • Oldendick, R. W. — Bishop, G. F. — Sorenson, S. B. — Tuchfarber, A. J. (1988): A Comparison of the Kish and Last-birthday Methods of Respondent Selection in Telephone Surveys. Journal of Official Statistics 4: 307–318.

    Tuchfarber A. J. , 'A Comparison of the Kish and Last-birthday Methods of Respondent Selection in Telephone Surveys ' (1988 ) 4 Journal of Official Statistics : 307 -318.

    • Search Google Scholar
  • Pavlova, M. — Groot, W. — van Merode, G. (2003): The Importance of Quality, Access and Price to Health Care Consumers in Bulgaria: A Self-explicated Approach. International Journal of Health Planning and Management 18(4): 343–361.

    Merode G. , 'The Importance of Quality, Access and Price to Health Care Consumers in Bulgaria: A Self-explicated Approach ' (2003 ) 18 International Journal of Health Planning and Management : 343 -361.

    • Search Google Scholar
  • Ryan, M. — Gerard, K. (2003): Using Discrete Choice Experiments to Value Health Care Programmes: Current Practice and Future Research Reflections. Applied Health Economics and Health Policy 2: 55–64.

    Gerard K. , 'Using Discrete Choice Experiments to Value Health Care Programmes: Current Practice and Future Research Reflections ' (2003 ) 2 Applied Health Economics and Health Policy : 55 -64.

    • Search Google Scholar
  • Ryan, M. — Watson, V. (2009): Comparing Welfare Estimates from Payment Card Contingent Valuation and Discrete Choice Experiments. Health Economics 2009 18(4): 389–401.

    Watson V. , 'Comparing Welfare Estimates from Payment Card Contingent Valuation and Discrete Choice Experiments ' (2009 ) 200918 Health Economics : 389 -401.

    • Search Google Scholar
  • Ryan, M. — Scott, D. A. — Reeves, C. — Bate, A. — van Teijlingen, E. R. — Russell, E. M. — Napper, M. — Robb, C. M. (2001): Eliciting Public Preferences for Healthcare: A Systematic Review of Techniques. Health Technology Assessment 5(5): 1–186.

    Robb C. M. , 'Eliciting Public Preferences for Healthcare: A Systematic Review of Techniques ' (2001 ) 5 Health Technology Assessment : 1 -186.

    • Search Google Scholar
  • Szolgáltatásokért [Patient Payments — Willingness of the Hungarian Population to Pay for Health Care Services]. Esély 4: 106–117.

  • Telser, H. — Zweifel, P. (2002): Measuring Willingness-to-pay for Risk Reduction: An Application of Conjoint Analysis. Health Economics 11: 129–139.

    Zweifel P. , 'Measuring Willingness-to-pay for Risk Reduction: An Application of Conjoint Analysis ' (2002 ) 11 Health Economics : 129 -139.

    • Search Google Scholar
  • Tomini, S. — Groot, W. — Pavlova, M. (2011): Paying Informally in the Albanian Health Care Sector: ATwo-tiered Stochastic FrontierModel. European Journal of Health Economics (forthcoming).

  • Vitray, J. — Bakacs, M. — Gémes, K. — Kiss, N. — Kövi, R. — Uzzoli, A. (2011): Egészségügyi ellátáshoz való hozzáférés egyenlõtlenségei Magyarországon. Kutatási jelentés [Inequalities in the Access of Health Care Services in Hungary. Research Report]. Budapest: EgészségMonitor Kutató és Tanácsadó Nonprofit Közhasznú Kft.

    Uzzoli A. , '', in Egészségügyi ellátáshoz való hozzáférés egyenlõtlenségei Magyarországon. Kutatási jelentés , (2011 ) -.

  • Vroomen, J. M. — Zweifel, P. (2011): Preferences for Health Insurance and Health Status: Does it Matter Whether you are Dutch or German? European Journal of Health Economics 12(1): 87–95.

    Zweifel P. , 'Preferences for Health Insurance and Health Status: Does it Matter Whether you are Dutch or German? ' (2011 ) 12 European Journal of Health Economics : 87 -95.

    • Search Google Scholar