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Background: Most applications of choice-based conjoint analysis in health use choice tasks with only two profiles, while those in marketing routinely use three or more. This study reports on a randomized trial comparing paired with triplet profile choice formats focused on measuring patient preference for hearing aids. Methods: Respondents with hearing loss were drawn from a nationally representative cohort, completed identical surveys incorporating a conjoint analysis, but were randomized to choice tasks with two or three profiles. Baseline differences between the two groups were explored using ANOVA and chi-square tests. The primary outcomes of differences in estimated preferences were explored using t-tests, likelihood ratio tests, and analysis of individual-level models estimated with ordinary least squares. Results: 500 respondents were recruited. 127 had no hearing loss, 28 had profound loss and 22 declined to participate and were not analyzed. Of the remaining 323 participants, 146 individuals were randomized to the pairs and 177 to triplets. The only significant difference between the groups was time to complete the survey (11.5 and 21 minutes respectively). Pairs and triplets produced identical rankings of attribute importance but homogeneity was rejected (P<0.0001). Pairs led to more variation, and were systematically biased toward the null because a third (32.2%) of respondents focused on only one attribute. This is in contrast to respondents in the triplet design who traded across all attributes. Discussion: The number of profiles in choice tasks affects the results of conjoint analysis studies. Here triplets are preferred to pairs as they avoid non-trading and allow for more accurate estimation of preferences models.

Zonder onderwerpscode: economie

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Price transparency is one strategy that policymakers have proposed to help consumers identify and select lower-priced health care providers and services, but use of price transparency websites remains low. This report examines current price transparency efforts and their features, describes barriers to more widespread availability and use of price information, and discusses possible ways to overcome those barriers. RAND researchers, together with the Office of the Assistant Secretary for Planning and Evaluation within the U.S. Department of Health and Human Services, convened a panel of experts on price transparency to discuss these issues. Six key themes emerged: (1) Consumers are not often shopping before receiving services, (2) price information is difficult to access during services; (3) price transparency information can be misleading or inaccurate; (4) organizations lack common definitions, standards, and methodologies for sharing price data; (5) increasing the number of state all-payer claims databases may improve stakeholder access to price information; and (6) legal and regulatory barriers prevent the sharing of price data. The panel suggested a number of ways that the federal government could promote the availability and use of price information for stakeholders.

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In response to the Patient Protection and Affordable Care Act, health care organizations have sought ways to increase efficiency quickly, improve their ability to coordinate care, and enhance patient outcomes as reflected in publicly available performance measures. One such response has been the emergence of the clinically integrated network (CIN), commonly defined as a group of health care providers that join together to improve patient care, reduce costs, and demonstrate market value. The Federal Trade Commission (FTC) and U.S. Department of Justice have jointly provided guidance for CINs to determine whether cooperation among these otherwise competing organizations to jointly negotiate fees runs afoul of antitrust law. However, little is known about whether CINs conform to FTC guidance. The FTC does not formally monitor CINs, and health systems wanting to establish a CIN are not required to seek FTC approval. As a result, CINs are basically invisible to regulators and health services researchers, although CINs have the potential to produce negative market effects, such as increasing prices without a corresponding increase in quality. In this report, the authors offer an initial assessment of CINs based on interviews with health system executives, describe how health systems (large and small) are using CINs strategically to compete in crowded health care markets, and identify why CINs bear watching by the FTC and the larger health care community.