title: Population preferences for health care in liberia: insights for rebuilding a health system.
abstract: OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes.
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY 10032, USA. mkruk@columbia.edu
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rockers
authors.forename: S
authors.initials: S
authors.lastname: Tornorlah Varpilah
authors.forename: Rose
authors.initials: R
authors.lastname: Macauley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003153:Community Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration; D019037:Urban Health Services / Q000458:organization & administration; D055815:Young Adult