title: Contingent Valuation Analysis of an Otolaryngology and Ophthalmology Emergency Department: The Value of Acute Specialty Care.
abstract: Specialty emergency departments (EDs) provide a unique mechanism of health care delivery, but the value that they add to the medical system is not known. Evaluation of patient preferences to determine value can have a direct impact on resource allocation and direct-to-specialist care.
  
  
  
  To assess the feasibility of contingent valuation (CV) methodology using a willingness-to-pay (WTP) survey to evaluate specialty emergency services, in the context of an ophthalmology- and otolaryngology-specific ED.
  
  
  
  Contingent valuation analysis of a standalone otolaryngology and ophthalmology ED. Participants were English-speaking adults presenting to a dedicated otolaryngology and ophthalmology ED. The WTP questions were assessed using a payment card format, with reference to an alternative modality of treatment (ie, general ED), and were analyzed with multivariate regression.
  
  
  
  Validated WTP survey administered from October 14, 2014, through October 1, 2015.
  
  
  
  Sociodemographic data, level of distress, referral data, income, and WTP.
  
  
  
  A total of 327 of 423 (77.3%) ED patients responded to the WTP survey, with 116 ophthalmology and 211 otolaryngology patients included (52.3% female; mean [range] age, 46 [18-90] years). The most common reason for seeking care at this facility was a reputation for specialty care for both ear, nose, and throat (80 [37.9%]) and ophthalmology (43 [37.1%]). Mean WTP for specialty-specific ED services was $377 for ophthalmology patients, and $321 for otolaryngology patients ($340 overall; 95% CI, $294 to $386), without significant difference between groups (absolute difference, $56; 95% CI, $-156 to $43). Self-reported level of distress was higher among ear, nose, and throat vs ophthalmology patients (absolute difference, 0.47 on a Likert scale of 1-7; 95% CI, 0.10 to 0.84). Neither level of distress, income, nor demographic characteristics influenced WTP, but patients with higher estimates of total visit cost were more likely to have higher WTP (β coefficient, 0.27; SE, 0.05; adjusted R2 = 0.17 for model).
  
  
  
  Patients with eye and ear, nose, and throat complaints place a mean explicit value on specialty emergency services of $340 per visit, relative to general emergency care. Ultimately, CV data using WTP methodology are useful in valuing patient preferences in monetary terms and can help inform state-wide resource allocation and the availability of direct-to-specialist care.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Naunheim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elliot D
authors.initials: ED
authors.lastname: Kozin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rosh K
authors.initials: RK
authors.lastname: Sethi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: H G
authors.initials: HG
authors.lastname: Ota
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts3Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D010036:Otolaryngology; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D055815:Young Adult