title: How to reform western care payment systems according to physicians, policy makers, healthcare executives and researchers: a discrete choice experiment.
abstract: BACKGROUND
  Many developed countries are reforming healthcare payment systems in order to limit costs and improve clinical outcomes. Knowledge on how different groups of professional stakeholders trade off the merits and downsides of healthcare payment systems is limited.
  
  
  METHODS
  Using a discrete choice experiment we asked a sample of physicians, policy makers, healthcare executives and researchers from Canada, Europe, Oceania, and the United States to choose between profiles of hypothetical outcomes on eleven healthcare performance objectives which may arise from a healthcare payment system reform. We used a Bayesian D-optimal design with partial profiles, which enables studying a large number of attributes, i.e. the eleven performance objectives, in the experiment.
  
  
  RESULTS
  Our findings suggest that (a) moving from current payment systems to a value-based system is supported by physicians, despite an income trade-off, if effectiveness and long term cost containment improve. (b) Physicians would gain in terms of overall objective fulfillment in Eastern Europe and the US, but not in Canada, Oceania and Western Europe. Finally, (c) such payment reform more closely aligns the overall fulfillment of objectives between stakeholders such as physicians versus healthcare executives.
  
  
  CONCLUSIONS
  Although the findings should be interpreted with caution due to the potential selection effects of participants, it seems that the value driven nature of newly proposed and/or introduced care payment reforms is more closely aligned with what stakeholders favor in some health systems, but not in others. Future studies, including the use of random samples, should examine the contextual factors that explain such differences in values and buy-in.
  
  
  BACKGROUND
  C90, C99, E61, I11, I18, O57.
authors.affiliation: Faculty of Applied Economics, Department of Economics & StatUa Center for Statistics, University of Antwerp, Prinsstraat 13, B-2000, Antwerpen, Belgium. roselinde.kessels@uantwerpen.be.
authors.forename: Roselinde
authors.initials: R
authors.lastname: Kessels
authors.affiliation: Department of Public Health and Primary Care, Catholic University of Leuven, Kapucijnenvoer 35, B-3000, Leuven, Belgium. pieter.vanherck@med.kuleuven.be.
authors.forename: Pieter
authors.initials: P
authors.lastname: Van Herck
authors.affiliation: Department of Public Health and Primary Care, Catholic University of Leuven, Kapucijnenvoer 35, B-3000, Leuven, Belgium. e.a.dancet@amc.uva.nl.|Academic Medical Center, Women's and Children's Hospital, Center for Reproductive Medicine, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. e.a.dancet@amc.uva.nl.|Leuven University Fertility Center, Leuven University Hospitals, Herestraat 49, B-3000, Leuven, Belgium. e.a.dancet@amc.uva.nl.
authors.forename: Eline
authors.initials: E
authors.lastname: Dancet
authors.affiliation: Department of Public Health, I-CHER, Ghent University, De Pintelaan 185, B-9000, Ghent, Belgium. lieven.annemans@ugent.be.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Department of Public Health and Primary Care, Catholic University of Leuven, Kapucijnenvoer 35, B-3000, Leuven, Belgium. walter.sermeus@med.kuleuven.be.
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D001499:Bayes Theorem; D002170:Canada; D003363:Cost Control / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics; D005060:Europe; D005061:Europe, Eastern; D005260:Female; D018166:Health Care Reform / Q000191:economics; D005102:Health Expenditures; D006270:Health Facility Administrators / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D012051:Reimbursement Mechanisms; D012108:Research Personnel / Q000523:psychology*; D014481:United States