Discrete-Choice-Experimente zur Messung der Zahlungsbereitschaft für Gesundheitsleistungen – ein anwendungsbezogener Literaturreview

D. Rottenkolber

doi:10.1055/s-0029-1245852

Gesundheitsökonomie & Qualitätsmanagement, Table of Contents

Gesundheitsökonomie & Qualitätsmanagement 2011; 16(4): 232-244
DOI: 10.1055/s-0029-1245852

Originalarbeit

Discrete-Choice-Experimente zur Messung der Zahlungsbereitschaft für Gesundheitsleistungen – ein anwendungsbezogener Literaturreview

Discrete Choice Experiments for Measurement of Willingness-to-Pay for Healthcare Services – an Application-Oriented Literature ReviewD. Rottenkolber¹

¹Lehrstuhl für Gesundheitsökonomie und Management im Gesundheitswesen, Ludwig-Maximilians-Universität München
²Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München – Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Neuherberg

Abstract

Zusammenfassung

Zielsetzung: Discrete-Choice-Experimente (DCE) sind eine Methode zur Messung der Zahlungsbereitschaft im Kontext von Kosten-Nutzen-Analysen. Verglichen mit herkömmlichen Verfahren bieten DCE vielseitige Ansatzpunkte zur Messung von Präferenzurteilen. Ziel dieser Arbeit war es, die praktischen Anwendungsmöglichkeiten von DCE im Rahmen der Zahlungsbereitschaftsmessung für medizinische Technologien zu untersuchen. Methodik: Literaturreview basierend auf computergestützter Literaturrecherche in medizinischen und wirtschaftswissenschaftlichen Datenbanken (PubMed, EconLit) und bibliografische Suche in Literaturverzeichnissen im Veröffentlichungszeitraum von 01 / 1998 – 05 / 2010. Ergebnisse: Die Nutzenmessung mittels DCE bietet im Gegensatz zu anderen Methoden zwei Vorteile: Zum einen ist das Experiment für die Probanden leicht durchzuführen und zum anderen basieren der Zahlungsbereitschaftsansatz und DCE auf fundierten theoretischen Grundlagen. Aus der Literatur wurden die Validität, Reliabilität, Akzeptanz bei den befragten Personen, Praktikabilität und Wirtschaftlichkeit als Beurteilungskriterien für DCE evaluiert. Auf methodischer Ebene erweisen sich diese als ein Nutzenmaß von hoher Validität und Reliabilität. Besonders die Ergebnisse im Bereich der internen Konsistenz und der theoretischen Validität sind sehr gut. DCE können hilfreiche Anhaltspunkte liefern, insbesondere bei der Identifizierung von nutzenstiftenden Eigenschaften medizinischer Serviceleistungen, bei der Eliminierung von Leistungsbestandteilen, für die keine Zahlungsbereitschaft besteht, und bei der Konzeption von Leistungsangeboten für spezifische Patientengruppen. Die besten Ergebnisse lassen sich erzielen, wenn die befragten Personen mit der Entscheidungssituation vertraut sind. Schwierigkeiten in diesem Zusammenhang bestehen insbesondere in öffentlich finanzierten Gesundheitssystemen, in denen die Preissensitivität der Probanden nicht hinreichend genug ausgeprägt ist. Schlussfolgerung: DCE sind ein leistungsstarkes Verfahren, mit dem neben gesundheitsbezogenen Folgen auch Prozessattribute bewertet und Trade-Offs der Probanden zwischen einzelnen Produktattributen beobachtet werden können. Durch die Nachbildung von alltagstypischen Entscheidungssituationen können insbesondere interventionsspezifische Auswirkungen ermittelt werden. Dennoch erscheint es angebracht, zahlreiche Aspekte einer weiteren empirischen Überprüfung zu unterziehen. Hinsichtlich der Zahlungsbereitschaftsmessung sind Fragen bezüglich des optimalen Designs, psychologischer Aspekte und kognitiver Probleme der Entscheidungsfindung zu berücksichtigen.

Abstract

Aim: Discrete choice experiments (DCE) are a method to assess willingness-to-pay (WTP) within the framework of cost-benefit analysis. Compared to traditional tools, DCE offer a broad application spectrum for the measurement of preferences. The objective of this paper was to evaluate the application of DCE in the measurement of willingness-to-pay for medical interventions. Method: A literature review was conducted in healthcare and economic databases (PubMed, EconLit), as well as manual search and citation-tracking in bibliographies for papers and books published in the period 01 / 1998 – 05 / 2010. Results: Compared to conventional methods, utility measurement using DCE provides two advantages. First, the experiment is less cognitive demanding for respondents. Second, willingness-to-pay and DCE are based on a valid theoretical basis. From the literature, validity, reliability, acceptance by respondents, practicability, and efficiency were evaluated as criteria for assessing DCE. These criteria proved to be of high methodological validity and reliability. Particularly, the results concerning internal consistency and theoretical validity are very encouraging. DCE provide an informative basis for identifying medical service features which create a higher benefit for patients, eliminating services for which no willingness-to-pay exists, and the conception of medical services offered to specific patient groups. Optimized results may be achieved if the respondents are familiar with the framing of the decision situation. Particularly in healthcare systems where respondents exhibit inadequate price sensitivity, this may be a difficulty. Conclusion: DCE are a versatile tool for WTP measurement in health economics, which enables researchers both to evaluate process attributes and to observe individual trade-offs between service attributes. By mimicking everyday decision-making situations the method is especially suitable for the evaluation of intervention-specific effects. However, numerous criteria require empirical examination. Focusing on WTP measurement, aside from experimental design aspects, particularly psychological aspects and cognitive problems of decision heuristics should be taken into consideration.

Schlüsselwörter

Präferenzmessung - Discrete-Choice-Experiment - Zahlungsbereitschaft

Key words

preferences - discrete choice experiment - willingness-to-pay

Full Text

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Dipl.-Kfm. Dominik Rottenkolber, MBR

Lehrstuhl für Gesundheitsökonomie und Management im Gesundheitswesen, Ludwig-Maximilians-Universität München

Ludwigstr. 28 RG

80539 München

Email: rottenkolber@bwl.lmu.de