1
|
Nouwens SPH, Marceta SM, Bui M, van Dijk DMAH, Groothuis-Oudshoorn CGM, Veldwijk J, van Til JA, de Bekker-Grob EW. The Evolving Landscape of Discrete Choice Experiments in Health Economics: A Systematic Review. PHARMACOECONOMICS 2025:10.1007/s40273-025-01495-y. [PMID: 40397369 DOI: 10.1007/s40273-025-01495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2025] [Indexed: 05/22/2025]
Abstract
INTRODUCTION Stakeholder preference evaluations are increasingly emphasized in healthcare policy and health technology assessment. Discrete choice experiments (DCEs) are the most common method for quantifying preferences among patients, the public, and healthcare professionals. While prior reviews (1990-2017) have examined DCE trends, no comprehensive synthesis exists for studies published since 2018. This updated review (2018-2023) provides critical insights into evolving methodologies and global trends in health-related DCEs. METHODS A systematic search (2018-2023) of Medline, Embase, and Web of Science identified relevant studies. Studies were screened for inclusion and data were extracted, including details on DCE design and analysis. To enable trend comparisons, the search strategy and extraction items aligned with previous reviews. RESULTS Of 2663 identified papers, 1279 met the inclusion criteria, reflecting a significant rise in published DCEs over time. DCEs were conducted globally, with a remarkable increase in publications from Asia and Africa compared with previous reviews. Experimental designs and econometric models have advanced, continuing prior trends. Notably, most recent DCEs were administered online. DISCUSSION The rapid growth of DCE applications underscores their importance in health research. While the methodology is advancing rapidly, it is crucial that researchers provide full transparency in reporting their methods, particularly in detailing experimental designs and validity tests, which are too often overlooked. Key recommendations include improving reporting of experimental designs, applying validity tests, following good practices for presenting benefit-risk attributes, and adopting open science practices. Ensuring methodological rigor will maximize the impact and reproducibility of DCE research in health economics.
Collapse
Affiliation(s)
- Sven Petrus Henricus Nouwens
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands.
| | - Stella Maria Marceta
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Daisy Maria Alberta Hendrika van Dijk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | | | - Jorien Veldwijk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Janine Astrid van Til
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Esther Wilhelmina de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Lin L, Che Y, Zhou J, Gui Y, Zhang X. Trends in the practice environment of Chinese healthcare professionals from 2008 to 2023: an age period cohort analysis. HUMAN RESOURCES FOR HEALTH 2024; 22:76. [PMID: 39538262 PMCID: PMC11562610 DOI: 10.1186/s12960-024-00954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/04/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Healthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals' perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis. METHODS Four national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor-patient relationships were also analyzed. RESULTS Between 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28-38 during 2013-2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor-patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment. CONCLUSIONS The APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time.
Collapse
Affiliation(s)
- Liangquan Lin
- School of Marxism School of Humanities and Social Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, #9 Dongdan, 3nd Alley, Beijing, 100730, China
| | - Yi Che
- The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130021, China
| | - Jiaxin Zhou
- School of Marxism School of Humanities and Social Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, #9 Dongdan, 3nd Alley, Beijing, 100730, China
| | - Yixin Gui
- School of Marxism School of Humanities and Social Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, #9 Dongdan, 3nd Alley, Beijing, 100730, China
| | - Xinqing Zhang
- School of Marxism School of Humanities and Social Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, #9 Dongdan, 3nd Alley, Beijing, 100730, China.
| |
Collapse
|
3
|
Luo N, Bai R, Sun Y, Li X, Liu L, Xu X, Liu L. Job preferences of master of public health students in China: a discrete choice experiment. BMC MEDICAL EDUCATION 2024; 24:24. [PMID: 38178052 PMCID: PMC10768294 DOI: 10.1186/s12909-023-04993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The shortage of public health personnel and the uneven distribution between urban and rural areas are thorny issues in China. Master of public health (MPH) is an integral part of public health human resources in the future, and it is of far-reaching significance to discuss their work preferences. The present study wants to investigate the job preference of MPH, understand the relative importance of different job attributes, and then put forward targeted incentive measures. METHODS Discrete choice experiment (DCE) was used to evaluate the job preference of MPHs in two medical colleges in Liaoning Province. Attributes include employment location, bianzhi, working environment, career development prospects, work value and monthly income. Thirty-six choice sets were developed using a fractional factorial design. Mixed logit models were used to analysis the DCE data. RESULTS The final sample comprised 327 MPHs. All the attributes and levels included in the study are statistically significant. Monthly income is the most important factor for MPHs. For non-economic factors, they value career development prospects most, followed by the employment location. Respondents' preferences are heterogeneous and influenced by individual characteristics. Subgroup analysis showed that respondents from different family backgrounds have different job preferences. Policy simulation suggested that respondents were most sensitive to a salary increase, and the combination of several non-economic factors can also achieve the same effect. CONCLUSIONS Economic factors and non-economic factors significantly affect the job preference of MPHs. To alleviate the shortage and uneven distribution of public health personnel, more effective policy intervention should comprehensively consider the incentive measures of the work itself and pay attention to the individual characteristics and family backgrounds of the target object.
Collapse
Affiliation(s)
- Nansheng Luo
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Ru Bai
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Yu Sun
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Xueying Li
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Libing Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China
| | - Xin Xu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, 110004, Shenyang, Liaoning, China.
| | - Li Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning, China.
| |
Collapse
|
4
|
Tian Z, Guo W, Zhai M, Li H. Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China. BMC MEDICAL EDUCATION 2023; 23:890. [PMID: 38012762 PMCID: PMC10680353 DOI: 10.1186/s12909-023-04873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Public health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students' preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute. METHODS Based on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students' stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute. RESULTS A total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students' WTP for a job located in the county or city is much lower than that of urban students. CONCLUSIONS The heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.
Collapse
Affiliation(s)
- Zhuang Tian
- School of Public Health, Jining Medical University, Jining, 272067, China
| | - Wei Guo
- Public Health Service Center in Rencheng District, Jining, 272412, China
| | - Min Zhai
- School of Public Health, Jining Medical University, Jining, 272067, China
| | - Hongmin Li
- School of Public Health, Jining Medical University, Jining, 272067, China.
| |
Collapse
|