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The monetary value of patient-centred care: results from a discrete choice experiment in Dutch fertility care.
Hum Reprod 2014; 29(8):1712-20HR

Abstract

STUDY QUESTION

What are patients and insurers willing to pay for different aspects of fertility care, with a particular focus on patient-centredness?

SUMMARY ANSWER

In fertility care, both patients and health insurers place a high value on patient-centred factors, also when taking into account the effectiveness of fertility care. WHAT IS KNOWN ALREADY?: The benefit patients derive from fertility treatment may arise from several aspects of their care, such as the effectiveness, safety or patient-centred factors. Patient-centredness is recognized as an important, multi-dimensional concept, including domains on the organizational level (e.g. information provision) and on the human level (e.g. patient involvement).

STUDY DESIGN, SIZE, AND DURATION

We performed a discrete choice experiment (DCE) within 32 Dutch fertility clinics and five large health insurance companies in the Netherlands. A total of 996 infertile patients who underwent at least one treatment cycle for their fertility problem and 84 healthcare insurers participated in the study which was executed in the summer of 2012.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All participating patients and health insurers completed a DCE about their preferences in fertility care regarding the effectiveness, patient-centredness of care and additional costs. Logistic regression analysis was subsequently used to determine what both patients and health insurers were willing to pay for a one-step increase in patient-centred care and 1% higher pregnancy rates.

MAIN RESULTS AND THE ROLE OF CHANCE

Five hundred and fifty patients (55.2%) and 45 healthcare insurers (53.6%) completed the DCE questionnaire. Patients were willing to pay a median amount of €463 for a relevant one-step increase in patient-centred care and €107 for 1% increase in pregnancy rates. Healthcare insurers' valuations were lower: €191 for more patient-centred care and €60 for 1% increase in pregnancy rates. The willingness-to-pay values depended on patients' age, patients' ethnicity, income, and treatment type and on health insurers' age.

LIMITATIONS, REASONS FOR CAUTION

An important limitation of a DCE study is that other attributes, that were not included in our study, are relevant as well. Therefore, our study participants might make other choices in real life compared with our hypothetical DCE scenarios. We tried to prevent this potential bias by selecting the most important attributes from the literature, using the input of an expert panel and performing a pilot study to test the validity of our questionnaire.

WIDER IMPLICATIONS OF THE FINDINGS

This study emphasizes the importance of patient-centredness aspects of care for both infertile patients and their insurers. Therefore, efforts by policymakers and clinicians to improve these aspects of care would increase the overall value patients derive from their fertility treatment. Moreover, although insurers placed a lower monetary value on patient-centredness aspects than patients, it is arguable that insurers' purchasing decisions should be guided by patient rather than insurer preferences. Finally, given the relatively high monetary value patients place on patient-centred aspects of their fertility care, there may be a willingness to allow for some optional co-payments for this quality of care dimension.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by Merck Sharp and Dohme, the Netherlands. No competing interests declared.

TRIAL REGISTRATION NUMBER

Clinical Trials NCT01834313.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands dana.huppelschoten@radboudumc.nl.Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.The King's Fund, 11-13 Cavendish Square, London W1G 0AN, UK.Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24903199

Citation

Huppelschoten, Aleida G., et al. "The Monetary Value of Patient-centred Care: Results From a Discrete Choice Experiment in Dutch Fertility Care." Human Reproduction (Oxford, England), vol. 29, no. 8, 2014, pp. 1712-20.
Huppelschoten AG, Verkerk EW, Appleby J, et al. The monetary value of patient-centred care: results from a discrete choice experiment in Dutch fertility care. Hum Reprod. 2014;29(8):1712-20.
Huppelschoten, A. G., Verkerk, E. W., Appleby, J., Groenewoud, H., Adang, E. M., Nelen, W. L., & Kremer, J. A. (2014). The monetary value of patient-centred care: results from a discrete choice experiment in Dutch fertility care. Human Reproduction (Oxford, England), 29(8), pp. 1712-20. doi:10.1093/humrep/deu122.
Huppelschoten AG, et al. The Monetary Value of Patient-centred Care: Results From a Discrete Choice Experiment in Dutch Fertility Care. Hum Reprod. 2014;29(8):1712-20. PubMed PMID: 24903199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The monetary value of patient-centred care: results from a discrete choice experiment in Dutch fertility care. AU - Huppelschoten,Aleida G, AU - Verkerk,Eva W, AU - Appleby,John, AU - Groenewoud,Hans, AU - Adang,Eddy M M, AU - Nelen,Willianne L D M, AU - Kremer,Jan A M, Y1 - 2014/06/04/ PY - 2014/6/7/entrez PY - 2014/6/7/pubmed PY - 2015/4/8/medline KW - discrete choice experiment KW - health insurers KW - patient-centredness KW - preferences KW - willingness-to-pay SP - 1712 EP - 20 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 29 IS - 8 N2 - STUDY QUESTION: What are patients and insurers willing to pay for different aspects of fertility care, with a particular focus on patient-centredness? SUMMARY ANSWER: In fertility care, both patients and health insurers place a high value on patient-centred factors, also when taking into account the effectiveness of fertility care. WHAT IS KNOWN ALREADY?: The benefit patients derive from fertility treatment may arise from several aspects of their care, such as the effectiveness, safety or patient-centred factors. Patient-centredness is recognized as an important, multi-dimensional concept, including domains on the organizational level (e.g. information provision) and on the human level (e.g. patient involvement). STUDY DESIGN, SIZE, AND DURATION: We performed a discrete choice experiment (DCE) within 32 Dutch fertility clinics and five large health insurance companies in the Netherlands. A total of 996 infertile patients who underwent at least one treatment cycle for their fertility problem and 84 healthcare insurers participated in the study which was executed in the summer of 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: All participating patients and health insurers completed a DCE about their preferences in fertility care regarding the effectiveness, patient-centredness of care and additional costs. Logistic regression analysis was subsequently used to determine what both patients and health insurers were willing to pay for a one-step increase in patient-centred care and 1% higher pregnancy rates. MAIN RESULTS AND THE ROLE OF CHANCE: Five hundred and fifty patients (55.2%) and 45 healthcare insurers (53.6%) completed the DCE questionnaire. Patients were willing to pay a median amount of €463 for a relevant one-step increase in patient-centred care and €107 for 1% increase in pregnancy rates. Healthcare insurers' valuations were lower: €191 for more patient-centred care and €60 for 1% increase in pregnancy rates. The willingness-to-pay values depended on patients' age, patients' ethnicity, income, and treatment type and on health insurers' age. LIMITATIONS, REASONS FOR CAUTION: An important limitation of a DCE study is that other attributes, that were not included in our study, are relevant as well. Therefore, our study participants might make other choices in real life compared with our hypothetical DCE scenarios. We tried to prevent this potential bias by selecting the most important attributes from the literature, using the input of an expert panel and performing a pilot study to test the validity of our questionnaire. WIDER IMPLICATIONS OF THE FINDINGS: This study emphasizes the importance of patient-centredness aspects of care for both infertile patients and their insurers. Therefore, efforts by policymakers and clinicians to improve these aspects of care would increase the overall value patients derive from their fertility treatment. Moreover, although insurers placed a lower monetary value on patient-centredness aspects than patients, it is arguable that insurers' purchasing decisions should be guided by patient rather than insurer preferences. Finally, given the relatively high monetary value patients place on patient-centred aspects of their fertility care, there may be a willingness to allow for some optional co-payments for this quality of care dimension. STUDY FUNDING/COMPETING INTERESTS: This work was supported by Merck Sharp and Dohme, the Netherlands. No competing interests declared. TRIAL REGISTRATION NUMBER: Clinical Trials NCT01834313. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/24903199/The_monetary_value_of_patient_centred_care:_results_from_a_discrete_choice_experiment_in_Dutch_fertility_care_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/deu122 DB - PRIME DP - Unbound Medicine ER -