Measuring preferences for living in U.S. states: a comparison of the rating scale, time trade-off, and standard gamble.

If you could choose to live in a place in the United States that met all of your preferences and needs, where would it be? The "perfect state," of course, but does such a place exist? Judging places from best to worst has become an American pastime. Several surveys that rate the quality of life in different metropolitan areas are published annually (1-3). Not surprisingly, the results of these surveys vary widely due to differences in their research methods. We sought to measure preferences for living in U.S. states using three preference measurement techniques that are more commonly used to elicit utilities for health states: the rating scale, time trade-off, and standard gamble. These utility-assessment approaches yield values that can be used to compare preferences in a variety of locations and metropolitan areas in the United States. In this paper we report on our measurement of preferences for living in the United States of 42 individuals who participated in a utility-assessment exercise. Descriptions were developed for five locations in the United States: San Francisco, Calif; Seattle, Wash; New York, NY; Gainesville, Fla; and Gary, Ind. Seven attributes were used to describe each state: cost of living, availability of fine restaurants, climate, commuting time, availability of art museums and galleries, recreation potential, and risk of natural disasters. Utilities were elicited relative to a hypothetical "perfect state" and "worst state." Utilities ranged from a score of 0 to a score of 100, with higher scores reflecting more attractive states. Eighty-eight percent of the participants successfully completed the three preference measurement MATERIALS AND METHODS