-
Jesús Martín-Fernández,
M Isabel Del Cura-González,
Gemma Rodríguez-Martínez,
Gloria Ariza-Cardiel,
Javier Zamora, Tomás Gómez-Gascón,
Elena Polentinos-Castro,
Francisco Javier Pérez-Rivas,
Julia Domínguez-Bidagor,
Milagros Beamud-Lagos,
M Eugenia Tello-Bernabé,
Juan Francisco Conde-López,
Oscar Aguado-Arroyo,
M Teresa Sanz- Bayona,
Ana Isabel Gil-Lacruz
[show abstract]
[hide abstract]
ABSTRACT: Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users.
Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2-15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6-22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4-6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively).
The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of health services.
PLoS ONE 01/2013; 8(4):e62840. · 4.09 Impact Factor
-
Jesús Martín-Fernández,
Francisco Javier Pérez-Rivas, Tomás Gómez-Gascón,
Isabel del Cura-González,
Eugenia Tello Bernabé,
Gemma Rodríguez-Martínez,
Elena Polentinos-Castro,
Julia Domínguez-Bidagor,
Gloria Ariza-Cardiel,
Juan Francisco Conde-López,
Milagros Beamud-Lagos,
Oscar Aguado-Arroyo,
Teresa Sanz-Bayona,
Ana Isabel Gil-Lacruz
[show abstract]
[hide abstract]
ABSTRACT: ABSTRACT:
The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA).
This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP) for the care received from the primary care nurse and the willingness to accept [compensation] (WTA), were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively.
The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning, enabling incorporating patient preferences to health policy decision-making.
BMC Family Practice 10/2011; 12:109. · 1.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe patient satisfaction of their relationship with the family physician, using the PDRQ-9 questionnaire and assess its psychometric properties.
Cross-sectional study.
Six Primary Care Health centres in the Community of Madrid, Spain.
Four hundred and fifty one patients randomly selected from those who had just visited their family physician.
Interviews were carried out to collect demographic characteristics, health needs, the accessibility to the service, and the socioeconomic situation of the subjects.
The PDRQ-9 responses were collected and a synthetic satisfaction index was constructed. A multivariable model was designed to explain differences in satisfaction.
The mean satisfaction index was 4.41 (95% CI: 4.33-4.48) on a scale of 1 (the worst) to 5 (the best satisfaction possible), with a median of 4.78 (interquartile range 4.00-5.00). Four of every 10 subjects expressed the maximum possible satisfaction ("ceiling effect"). A single factor explained 75.3% of the variance, with a Cronbach alpha value of 0.952. Age (OR 1.03, 95% CI: 1.02-1.05) and living in rural areas (OR 1.44, 95% CI: 0.94-2.20) were associated with above average satisfaction.
Primary care users feel their relationship with their family physicians are very satisfactory, particularly in those who are older and who live in rural areas. The PDRQ-9 questionnaire shows a high internal consistency, but it is not good enough to discriminate in the upper part of the scale.
Atención Primaria 04/2010; 42(4):196-203. · 0.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The economic value attributed by users of health services in public health systems can be useful in planning and evaluation. This value can differ from the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA).Our objective was to study the perceptions of the patient about the service provided by the family physician by means of the WTA/WTP ratio.
An economic evaluation study by the Contingent Valuation Method was designed. Interviews were conducted with 451 subjects at six health centres (four urban and two rural) in areas with different socioeconomic characteristics. A payment card was used to measure the WTP and WTA. Other characteristics of the subject or service that could influence these responses were collected. An explicative model was constructed to study the WTA/WTP relationship.
Four hundred and four subjects (89.6%) expressed a WTP and WTA different from zero. The WTA/WTP quotient showed a median of 1.55 (interquartile range 1-3.08) and a mean of 3.30 (IC 95%: 2.84-3.75). The WTA/WTP ratio increases with age and in low-income areas. It decreases in professional groups with more specialized activities, with growing family income, and in the chronically ill. Other characteristics related to the perception of state of health, accessibility to the service, satisfaction, or perception of risk were not explicative.
Subjects who were older and had a less favourable socioeconomic situation expressed a higher WTA/WTP ratio when valuing the visit to the family physician. These characteristics could identify a profile of "aversion to loss" with respect to this service.
BMC Public Health 01/2010; 10:236. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Identify the economic value the user attributes to the visit to the family physician, in a setting of a National Health System, by the Willingness to Pay (WTP) expressed.
Economic evaluation study, by the contingent valuation method. Questions were asked about WTP using a payment card format. Interviews were conducted with 451 subjects, in areas with different socioeconomic characteristics. An ordered probit was used to evaluate model's validity.
Median WTP expressed was euro18 (interquartile range euro8-28), not including "zero-answers" of thirty-four subjects (7.5%). This value represents 2% of average adjusted family incomes. Patients with higher incomes or with chronic illnesses presented a probability of 5-14 percentage points of expressing a high WTP. For every point of increase of patient satisfaction, the probability of presenting a WTP in the lowest range decreases 7.0 percentage points. Subjects with a low education level and those older than 65 expressed a lower WTP. Accessibility, risk perception, nationality and having private insurance were not related to the WTP expressed.
Users of primary care have a clear perception of the economic value of care received from the family physician, even in a framework of providing services financed by taxes and without cost at the moment of use. This value increases in subjects with higher incomes, with greater need for care, or more satisfied.
Health Policy 11/2009; 94(3):266-72. · 1.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To establish the CVP-35 evaluative properties to measure the professional quality of life (PQL).
Prospective, observational study.
A primary care area in the Community of Madrid, Spain.
A total of 149 sanitary workers with some burnout sign measured by Maslach Burnout Inventory (MBI) participated.
They fulfilled MBI, Goldberg Health Questionnaire (GHQ-28), and CVP-35 questionnaires at the beginning and after a year of follow-up, in which 73 subjects took part in activities for coping stress. It was assessed the change of PQL and their domains managerial support (PQL-MS), work load (PQL-WL), intrinsic motivation (PQL-IM) for the subjects with variations at the MBI, or GHQ-28 punctuation greater than 0.5 SD of the initial distribution.
Variations in CVP-35 and their domains correlate weakly with changes in MBI and GHQ-28 (r<0.500), but they are congruent with the conceptual model. In the individuals with significant variations in the GHQ-28, they appreciate an average change in PQL and their domains between 0.18 and 0.55 points (absolute value). In those with significant variations in the MBI domains, PQL presented average absolute variations between 0.23 and 0.45 points, PQL-MS between 0.30 and 0.67, PQL-WL between 0.01 and 0.55 and PQL-IM between 0.22 and 0.83 points.
CVP-35 is a sensitive-to-change instrument under population point of view. Changes in PQL perception or in any of their domains of 0.5 points could be pointed as relevant.
Atención Primaria 07/2008; 40(7):327-34. · 0.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fundamento: La utilización de servicios sanitarios se ha estudiado desde varios modelos conceptuales. El objetivo de este trabajo es valorar la influencia de la calidad de vida relacionada con la salud (CVRS) en la variabilidad de la utilización de la consulta de atención primaria bajo el «modelo conductual». Métodos: Estudio transversal analítico. Se entrevistó a 451 sujetos de 6 centros de salud en la Comunidad de Madrid. Se recogieron características relacionadas con factores ambientales e individuales (predisponentes, facilitadores y de necesidad) y la CVRS (Euroqol-5D). La utilización se recogió de la historia clínica informatizada. Resultados: Hubo una mediana de 13 visitas/año (rango intercuartil 7-20). La CVRS explicaba un 5,2% de la variabilidad en la utilización, vivir en barrios de rentas altas un 2,4%, la edad un 7,4%, la renta individual un 1,0% y los factores relacionados con «necesidad» (enfermedades crónicas e ingresos hospitalarios) explicaban un 4,1% de variabilidad adicional. Cada cambio de tercil de la CVRS se asoció con una disminución del 13,8% en las consultas/año. La residencia en zonas de renta alta y cada aumento de 1000 de renta individual disminuían la utilización un 17,5% y un 9,5% respectivamente. La edad se asociaba con un aumento de un 8,0% de visitas/año por década. El sufrir enfermedades crónicas o ingresos hospitalarios suponía aumentar un 51,9% y un 26,5% las visitas anuales. Conclusiones: La CVRS se asocia de manera independiente con la variabilidad en la utilización de la consulta del médico de familia, una vez ajustado el efecto de la necesidad, como propone el «modelo conductual».
Revista española de salud pública, ISSN 1135-5727, Vol. 84, Nº. 3, 2010, pags. 293-303.
-
[show abstract]
[hide abstract]
ABSTRACT: Health services utilization has been studied under several conceptual models. This study is aimed to assess the influence of Health Related Quality of Life (HRQL) on the variability of the primary care consultation utilization under the
A cross-sectional study. Interviews were conducted with 451 subjects at six health centers in the Community of Madrid. Environmental and individual characteristics (predisposing, enabling and need factors) and HRQL (EuroQol-5D) were collected. Annual visits were retrieved from the computerized clinical history.
Median utilization was 13 visits/year (interquartile range 7-20). HRQL explained 5,2% of utilization variability, living in high-income areas an additional 2.4%, age a 7.4%, incomes a 1.0% and (chronic illnesses or a hospital admission in the last year) explained an additional 4.1% of the variability. Each increase of the tercile in the perception of HRQL was associated with a decrease of 13,8% of the number of visits/year. Living in high-income areas, and each increase of 1000 in the incomes decreased the percentage of annual visits 17.5 % and 9.5% respectively. Age is associated with an increase of 8.0% of annual visits per decade. Suffering from chronic illnesses or a hospital admission in the last year increased the average number of visits/year to 51.9 and 26.5%.
HRQL is independently associated with the variability of the demand for the family physician after adjusting by < health need> factors as the proposes.
Revista Española de Salud Pública 84(3):293-19. · 0.71 Impact Factor
