Patients’ preferences for attributes related to health care services at hospitals in Amhara Region, northern Ethiopia: a discrete choice experiment

BACKGROUND Information from the patient's point of view is essential in policy and clinical decisions. Prioritizing what patients value, need, and prefer in various aspects of a health program can be helpful in evaluating and designing hospital health care services. OBJECTIVE To examine patients' preference for attributes related to health care services and to ascertain the relative impact of attributes at hospitals in Amhara Region, northern Ethiopia. METHODS A stated-preference discrete choice experiment survey was performed in multistage, stratified, and systematic sampling of patients who visited the hospitals. Attributes were selected based on a literature review of the most important characteristics of hospital health care service and reviewed and validated with inputs from patients and researchers in the field. Attributes included in the study were waiting time, physician communication, nursing communication, drug availability, continuity of care, and diagnostic facilities. A random-effects probit model was used to perform the analysis. RESULTS One thousand and five respondents who received care in the outpatient and inpatient departments participated in the study. All attributes included in the study affected the choice of hospital. Patients were willing to wait up to 3.3 hours and 2.7 hours to get full drugs in the hospital and good nursing communication, respectively. The interaction terms indicate that preferences differ with the variables sex, occupation, and type of hospital. Patients expressed clear preferences in a decreasing order of all the significant attribute levels: a lot of diagnostic facilities, full drug availability, continuity of care, good nursing communication, partial drug availability, good physician communication, and shorter waiting time for the consultation. CONCLUSION Different hospital care attributes had a significant and different influence on patients' choice of hospital. The study informs about patients' preferences and the trade-offs among different possible process-related attributes. Decision makers should focus on patient preferences and consider selected attributes when designating hospital services, and hence to maximize patient satisfaction.