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

Figures & data

Table 1 Attributes and levels

Attribute	Level	Conceptual definitions
Waiting time for the consultation	1 h 2 h 3 h	Waiting time between arrivals at the outpatient departments of the hospital and getting the consultation.
Physician communication	Good	Likelihood that the physician has a friendly approach; provides patient information with understandable language about the illness, lab investigation, and treatment; reassures the patient; plus involves the patient in decisions.
	Moderate	Likelihood that physician is friendly approached; provides information with understandable language about the illness, lab investigation, and treatment; and apart from the stated key parameters, physician might have additional good qualities.
	Poor	Likelihood that the physician is not approached friendly; unlikely that the physician provides information with understandable language about the illness, lab investigation, or treatment.
Nursing communication	Good	Likelihood that the nurse is friendly approached; provides patient information with understandable language about the patient care and reassurance for the patient; plus involves the patient in decisions.
	Moderate	Likelihood that the nurse is friendly approached, provides information with understandable language about the patient care, and some more.
	Poor	Likelihood that the nurse is not approached friendly; unlikely that the nurse provides information with understandable language about the patient care; and some more.
Drug availability in the hospital pharmacy	Fully available	It is likely that all the drugs will be available.
	Partially available	It is likely that you will have to look for some of the drugs elsewhere.
	Not available	It is likely that you will have to look for all of the drugs elsewhere.
Continuity of care	Yes	It is likely that health care services are connected and coherent and are consistent with a patient’s health needs and personal circumstances.
	No	It is likely that that health care services are not connected and coherent and are unlikely consistent with a patient’s health needs and personal circumstances.
Diagnostic facilities	A lot of diagnostic facilities	Ultrasound scanner, MRI, biopsy, blood/urine sample, plus others.
	Some diagnostic facilities	Blood/urine analysis plus some more.
	A few diagnostic facilities	Blood pressure cuff and apart from blood pressure cuff, it might have other vital sign measurement materials.

Abbreviations: h, hour(s); MRI, magnetic resonance imaging.

Table 2 A sample pair of scenarios

Attributes	Hospital 1	Hospital 2
Physician communication	Poor	Good
Nursing communication	Good	Poor
Waiting time for the consultation	2 hours	1 hour
Drug availability in the hospital pharmacy	Fully available	Partially available
Continuity of care	No	Yes
Diagnostic facilities	A few diagnostic facilities	A lot of diagnostic facilities
Which hospital do you prefer?	1	2

Table 3 Sociodemographic characteristics of respondents (N=1,005)

Characteristics	Number	%
Age (years)
18–34	504	50.1
35–64	461	45.9
>64	40	4.0
Median (+ standard deviation)	34 (13.5)
Sex
Female	425	42.3
Male	580	57.3
Marital status
Married or cohabiting with partner	580	57.7
Divorced or separated	30	3.0
Widowed	57	5.7
Single	338	33.7
Educational status
Illiterate	209	20.8
Can read and write	115	11.4
Grades 1–8	215	21.4
Grades 9–12	177	17.6
Grades 11–12	91	9.1
Diploma and above	198	19.7
Occupation
Employed	160	15.9
Merchant	164	16.3
Farmer	515	51.2
No job	95	9.5
Other	71	7.1
Residence
Urban	364	36.2
Rural	641	63.8
Payment status
Paying	945	94
Free	60	6

Table 4 Main-effects model and MRSs – results from the discrete choice experiment

Variable	β	Standard error	P-value	MRS (h)	95% CI (lower)	95% CI (upper)
Waiting time	−0.773	0.348	0.026	–	–	–
Physician communication – good	0.233	0.091	0.011	0.301	−0.0042	0.6076
Physician communication – moderate	0.087	0.101	0.380	0.113	−0.1414	0.3685
Nursing communication – good	2.060	0.587	0.000	2.66	1.769	3.556
Nursing communication – moderate	0.859	0.622	0.168	1.11	0.4882	1.733
Drug availability – full	2.525	0.403	0.000	3.263	1.387	5.139
Drug availability – partial	1.309	0.423	0.002	1.692	1.253	2.13
Continuity of care – yes	0.937	0.254	0.000	1.211	0.774	1.649
Diagnostic facilities – a lot of	0.856	0.055	0.000	1.107	0.1518	2.062
Diagnostic facilities – some	−0.987	0.772	0.201	−1.276	−2.11	−0.439
Constant	0.085	0.357	0.811	–	–	–

Notes: Number of pairwise observations =8,040. LR χ²(10)=3,022.91. Probability >χ²=0.0000. Pseudo R²=0.2719. Log-likelihood =–4,047.1091.

Abbreviations: CI, confidence interval; h, hours; MRS, marginal rate of substitution; LR, likelihood ratio.

Table 5 Segmented model

Variable	β	Standard error
Waiting time	−0.3177**	0.016
Physician communication – good	0.2261**	0.039
Nursing communication – good	1.185**	0.043
Drug availability – full	2.048**	0.052
Drug availability – partial	0.7292**	0.038
Continuity of care – yes	0.5134**	0.032
Diagnostic facilities – a lot of	0.8955**	0.032
Good nursing communication^sex – female	−0.0734*	0.036
A lot of diagnostic facilities^sex – female	−0.1207**	0.037
Good nursing communication^farmers	0.0894*	0.041
Partial drug availability^farmers	0.1010*	0.043
Partial drug availability^no jobs	0.1502*	0.072
Continuity of care^referral hospital	0.0811*	0.035
Constant	−0.4262**	0.041

Notes: Number of pairwise observations =8,040. Log-likelihood =−4,033.3225. LR χ²(13)=3,050.49.

^ McFadden’s pseudo R²=0.2744.

* P<0.05;

** P<0.001.

Table 6 Ranking of attribute importance using partial log-likelihood analysis (main effects)

Attribute level excluded from the analysis	Log-likelihood	Partial effect: change in log-likelihood	Relative effect: % sum of change in log-likelihood	Cumulative (%)	Order of impact
None	−4,047.1091
Diagnostic facilities – a lot of*	−4,119.382	−72.2729	0.6592	0.6592	1
Drug availability – full*	−4,061.7391	−14.63	0.1334	0.7926	2
Continuity of care*	−4,052.6839	−5.5748	0.0508	0.8434	3
Nursing communication – good*	−4,052.2646	−5.5155	0.0503	0.8937	4
Drug availability – partial*	−4,051.1625	−4.0534	0.0369	0.9306	5
Physician communication – good*	−4,050.4455	−3.3364	0.0304	0.9610	6
Waiting time*	−4,049.316	−2.2069	0.0201	0.9811	7
Nursing communication – moderate	−4,047.9985	−0.8894	0.0082	0.9893	8
Diagnostic facilities – some	−4,047.8814	−0.7723	0.0071	0.9964	9
Physician communication – moderate	−4,047.4936	−0.3845	0.0036	1.0000	10

Note:

* Significant in main-effects discrete choice experiment model.