Women’s Preferences for Birthing Hospital in Denmark: A Discrete Choice Experiment
Free choice of hospital has been introduced in many healthcare systems to accommodate patient preferences and incentivize hospitals to compete; however, little is known about what patients actually prefer.
This study assessed women’s preferences for birthing hospital in Denmark by quantifying the utility and trade-offs of hospital attributes.
We conducted a discrete-choice experiment survey with 12 hypothetical scenarios in which women had to choose between three hospitals characterized by five attributes: continuity of midwifery care, availability of a neonatal intensive care unit (NICU), hospital services offered, level of specialization to handle rare events, and travel time. A random parameter logit model was used to estimate the utility and marginal willingness to travel (WTT) for improvements in other hospital attributes.
A total of 517 women completed the survey. Significant preferences were expressed for all attributes (p < 0.01), with the availability of a NICU being the most important driver of women’s preferences; women were willing to travel 30 more minutes (95% confidence interval 28–32) to reach a hospital with a highly specialized NICU. The subgroup analyses revealed differences in WTT, with substantial heterogeneity due to prior experience with giving birth and regarding risk attitude and health literacy.
A high specialization level was the most influential factor for women without previous birth experience and for risk-averse individuals but not for women with a high health literacy score. Hence, more information about the woman’s risk profile and services required could play a role in affecting hospital choice.
The authors thank the volunteers for participating in individual and focus group interviews in the design phase of the study.
NTD contributed to the study design, data analysis, interpretation of results, drafting the manuscript, and reporting. MRM, DG-H, and RS contributed to the study design, data analysis, interpretation of results, writing, and reporting. NU contributed to study design to ensure the applicability and relevance of the survey instrument, writing and reporting. All authors approved the manuscript.
Compliance with Ethical Standards
The Central Denmark Region data approval committee approved the study (Journal number 1-16-02-40-15).
This study was funded by the Central Denmark Region Health Research Fund, Aarhus University and the Health Foundation (Grant number 15-B-0122).
Conflicts of interest
N. Tayyari Dehbarez, M. Raun Mørkbak, D. Gyrd-Hansen, N. Uldbjerg, and R. Søgaard have no conflicts of interest.
- 5.Moscelli G, Siciliani L, Gutacker N, Cookson R., Socioeconomic inequality of access to healthcare: Does patients’ choice explain the gradient? CHE Res.Pap. 2015;112.Google Scholar
- 7.Dawson D, Jacobs R, Martin S, Smith P. Evaluation of the London patient choice project: system wide impacts final report. September, 2004.Google Scholar
- 18.Dehbarez NT, Lou S, Uldbjerg N, Møller A, Gryd-Hansen D, Søgaard R. Pregnant women’s choice of birthing hospital: a qualitative study on individuals’ preferences. J Women Birth. https://doi.org/10.1016/j.wombi.2017.11.006.
- 20.ChoiceMetrics. Ngene 1.1.2 User manual & reference guide. 2014. http://www.choice-metrics.com. Accessed 22 Mar 2017.
- 21.Bierlaire M. BisonBiogeme 2.4: estimating a first model. 2015. Report TRANSPORT-OR 150720.Google Scholar
- 23.Galizzi MM, R. Miniaci R, Miniaci R. Temporal stability, cross-validity, and external validity of risk preferences measures: experimental evidence from a UK representative sample. SSRN Electron J. 2016. Working paper.Google Scholar
- 28.C.J. Bliemer M, M. Rose J, Confidence intervals of willingness-to-pay for random coefficient logit models. Working paper. The University of Sydney. 2013.Google Scholar