Trading patients’ choice in providers for quality of maternity care? A discrete choice experiment amongst pregnant women

Background
The introduction of bundled payment for maternity care, aimed at improving the quality of maternity care, may affect pregnant women’s choice in providers of maternity care. This paper describes a Dutch study which examined pregnant women’s preferences when choosing a maternity care provider. The study focused on factors that enhance the quality of maternity care versus (restricted) provider choice.
Methods
A discrete choice experiment was conducted amongst 611 pregnant women living in the Netherlands using an online questionnaire. The data were analysed with Latent Class Analyses. The outcome measure consisted of stated preferences in the discrete choice experiment. Included factors were: information exchange by care providers through electronic medical records, information provided by midwife, information provided by friends, freedom to choose maternity care provider and travel distance.
Results
Four different preference structures were found. In two of those structures, respondents found aspects of the maternity care related to quality of care more important than being able to choose a provider (provider choice). In the two other preference structures, respondents found provider choice more important than aspects related to quality of maternity care.
Conclusions
In a country with presumed high-quality maternity care like the Netherlands, about half of pregnant women prefer being able to choose their maternity care provider over organisational factors that might imply better quality of care. A comparable amount of women find quality-related aspects most important when choosing a maternity care provider and are willing to accept limitations in their choice of provider. These insights are relevant for policy makers in order to be able to design a bundled payment model which justify the preferences of all pregnant women.

研究背景
旨在提升产科护理质量的产科护理打包付费模式的推行，可能会对孕妇选择产科护理服务提供者的决策产生影响。本研究介绍了一项荷兰开展的研究，该研究旨在探究孕妇在选择产科护理服务提供者时的偏好，重点关注提升产科护理质量与（受限的）服务提供者选择权两类影响因素。

研究方法
本研究通过线上问卷，对居住在荷兰的611名孕妇开展了离散选择实验（discrete choice experiment），并采用潜类别分析（Latent Class Analyses）对数据进行分析。本次实验的结局指标为离散选择实验中受访者报告的偏好，纳入考量的影响因素包括：护理服务提供者通过电子病历开展的信息交互、助产士提供的健康信息、亲友提供的相关信息、产科护理服务提供者选择权以及出行距离。

研究结果
研究共识别出四种不同的偏好结构。其中两类偏好结构中，受访者认为与产科护理质量相关的维度比选择服务提供者的权利（服务提供者选择权）更为重要；剩余两类偏好结构中，受访者则更看重服务提供者选择权，而非产科护理质量相关维度。

研究结论
在荷兰这类产科护理质量被认为较高的国家中，约半数孕妇更倾向于拥有产科护理服务提供者选择权，而非可能带来更高护理质量的组织化付费模式相关因素；另有比例相近的孕妇则将护理质量相关维度视为选择产科护理服务时的首要考量因素，并愿意接受服务提供者选择范围受限的情况。上述研究结论可为政策制定者设计能够兼顾所有孕妇偏好的产科护理打包付费模式提供参考依据。