Case vignettes based on EQ-5D to elicit stated preferences for health services utilization from the insurees' perspective.
BACKGROUND
There is little evidence as to why or why not insurees decide to seek medical services. Steps prior to the entry of the insuree into the professional health care system have not been sufficiently examined and can only be partially described by secondary data of the statutory health insurance (SHI). We report the first investigation using case vignettes based on the generic health-related quality of life questionnaire EQ-5D as part of a choice study to assess insurees' stated preferences in health services utilization.


METHODS
We invited 1500 randomly selected citizens (age 30 to 70 years) from the East German state of Saxony-Anhalt by postal mail to participate in the choice study. Attributes of the case vignettes involved in choice tasks were the five dimensions of the EQ-5D. We used multilevel mixed effects logit regression analysis with the dependent variables: preference to seek medical services (model 1) and preferred time until consultation (model 2) for the assessed case vignette. The EQ-5D attributes of the case vignettes and participant characteristics served as the independent variables. We also included the respondent's certainty of choosing from the choice set, and the order of questions of the questionnaire as control variables.


RESULTS
Of the 1500 questionnaires 683 were evaluable (net response rate 48.0%). On the level of the case vignettes, problems in all five dimensions of the EQ-5D were statistically significant factors of the estimated likelihood to seek medical services (model 1). On the respondent level, there was a significant relationship between the preference for medical consultation for the assessed case vignette and the respondent's gender, age, educational level, the existence of a regular doctor, and the certainty of choosing from the choice set. Problems in four of the five dimensions of the EQ-5D (except anxiety/depression) of the case vignettes were significantly associated with the preferred time until consultation (model 2). On the respondent level, gender, educational level, the certainty of choosing from the choice set, and the order of questions of the questionnaire were significant determinants of the time until consultation.


CONCLUSIONS
Our study offers a promising new approach for the national and cross-national study of preferences in health services utilization from the insurees' perspective.
Institute of Social Medicine and Health Economics, University of Magdeburg, Magdeburg, Germany. julia.e.eckert@gmail.com.
Julia
J
Eckert
Institute of Social Medicine and Health Economics, University of Magdeburg, Magdeburg, Germany. marcel.lichters@ovgu.de.|Department of Business Studies, Harz University of Applied Sciences, Wernigerode, Germany. marcel.lichters@ovgu.de.|Department of Empirical Economics, Faculty of Economics and Management, University Magdeburg, Magdeburg, Germany. marcel.lichters@ovgu.de.
Marcel
M
Lichters
Institute of Social Medicine and Health Economics, University of Magdeburg, Magdeburg, Germany. silke.piedmont@med.ovgu.de.
Silke
S
Piedmont
Institute of Social Medicine and Health Economics, University of Magdeburg, Magdeburg, Germany. bodo.vogt@ovgu.de.|Department of Empirical Economics, Faculty of Economics and Management, University Magdeburg, Magdeburg, Germany. bodo.vogt@ovgu.de.
Bodo
B
Vogt
Institute of Social Medicine and Health Economics, University of Magdeburg, Magdeburg, Germany. bernt-peter.robra@med.ovgu.de.
Bernt-Peter
BP
Robra
D000328:Adult; D000368:Aged; D002755:Choice Behavior; D005260:Female; D005858:Germany; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057240:Patient Preference; D011788:Quality of Life; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment; D055815:Young Adult