Patient preferences for integrated care networks in Germany: a Discrete-Choice Experiment (DCE)

Background: Crucial factor of effective healthcare systems is patient-centered care. The design of healthcare delivery networks should be aligned to the needs and priorities of patients. The objective of this study was to analyze the preferences of German patients for specific characteristics of healthcare delivery. Methods: Preferences over 21 attributes were elicited using a DCE in a randomized survey. The experiment included 4 DCE-blocks with 6 attributes. Temporal and psychological distances were randomized as information base for respondents’ decision (diagnosis tomorrow, diagnosis for a stranger, diagnosis in 1 year). The price attribute was considered identical in all DCEs. Results: N=1610 participated in the survey. Using a quota-drawing-method a representative sample was collected. "Price" was of the highest relevance in all four blocks (DCE1: Coefficient: 1.1109; 2: Coefficient: 1.24438; 3: Coefficient: 1.0644; 4: coefficient: 1.0516). In DCE1 (patient orientation) "education and training" (Coef.: 0.2786) was of great importance, in DCE2 (patient care) it was "waiting for an appointment" (Coef.: 0.3890). In DCE3 (staff) "Experience" (Coef.: 0.3312) had strong influence on decisions. In the final DCE (organization) "Medical devices and equipment" (Coef.: 0.5979) were highly relevant. Conclusion: The study proposed to present patient preferences with regard to integrated care networks. The combination of choice-based experiments with behavioral economic approaches shows a systematic variation in preferences by the temporal and psychological distance. Overall, the study shows that patients put a high value on the state of medical equipment.