title: Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment.
abstract: BACKGROUND
  The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services.
  
  
  METHODS
  A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape.
  
  
  RESULTS
  The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes.
  
  
  CONCLUSIONS
  Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision.
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, South Africa, Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2QN, UK and Institute of Social and Economic Research, Rhodes University, Grahamstown, 6139, South Africa ayako.honda@uct.ac.za.
authors.forename: Ayako
authors.initials: A
authors.lastname: Honda
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, South Africa, Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2QN, UK and Institute of Social and Economic Research, Rhodes University, Grahamstown, 6139, South Africa.
authors.forename: Mandy
authors.initials: M
authors.lastname: Ryan
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, South Africa, Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2QN, UK and Institute of Social and Economic Research, Rhodes University, Grahamstown, 6139, South Africa.
authors.forename: Robert
authors.initials: R
authors.lastname: van Niekerk
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, 7925, South Africa, Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2QN, UK and Institute of Social and Economic Research, Rhodes University, Grahamstown, 6139, South Africa.
authors.forename: Diane
authors.initials: D
authors.lastname: McIntyre
mesh_terms: D006268:Health Facilities / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D015233:Models, Statistical; D009313:National Health Programs / Q000592:standards; D057240:Patient Preference; D011634:Public Health; D017150:Public Sector / Q000592:standards*; D011787:Quality of Health Care; D013019:South Africa; D019472:Universal Health Insurance
keywords: South Africa; discrete choice experiment; national health insurance; public preferences; quality of care