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ABSTRACT: In the Netherlands, pregnant women at low risk of complications during pregnancy, have the opportunity to choose freely between giving birth at home or in a hospital maternity unit. This study analyses how various attributes of obstetric care, socio-economic characteristics and attitudes influence the decisions that these women make with regard to obstetric care. The method of discrete-choice experiment was applied in the process of data collection and analysis. The data were collected among low-risk nulliparous pregnant women. The analysis suggests that there are strong preferences among some Dutch women for a home birth. Nevertheless, the absence of a medical pain-relief treatment during home birth, might provide incentives for some women to opt for a birth in a hospital, especially at the end of their pregnancy. If the attractiveness of home birth should be preserved in the Netherlands, specific attention should be paid on the approach to pain during a home birth. Efforts could also be made in offering a domestic atmosphere during hospital births to improve hospital-based obstetric care in view of women's preferences.
Health Policy 07/2009; 93(1):27-34. · 1.51 Impact Factor
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ABSTRACT: The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht.
The design was a comparative longitudinal study. The setting was a university hospital with a mixed intensive care unit (ICU), an IMC, and general wards. Changes in total hospital costs were measured for patients who were admitted to the ICU before and after the introduction of the IMC. The comparison of interest was the opening of a six-bed mixed IMC.
The mean total hospital cost per patient increased significantly. Before the introduction of the IMC, the total hospital cost per patient was n12,961 (+/- n14,530) and afterwards it rose to n16,513 (+/- n17,718). Multiple regression analysis was used to determine to what extent patient characteristics explained these higher hospital costs using mortality, type of stay, diagnostic categories, length of ICU and ward stay, and the Therapeutic Intervention Scoring System (TISS) as predictors. More surgical patients, greater requirements of therapeutic interventions on the ICU admission day, and longer ICU stay in patients did explain the increase in hospital costs, rather than the introduction of the IMC.
After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.
Critical care (London, England) 06/2008; 12(3):R68. · 4.61 Impact Factor
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ABSTRACT: Constant changes in society and the public health domain force public health professionals into new roles and the development of new competencies. Public health professionals will need to be trained to respond to this challenge. The aim of this comparative study among Poland, the UK and the Netherlands is to identify competence needs for Master of Public Health graduates entering the labour market from a European perspective. A self-administered questionnaire was sent to employers in the three countries, rating the importance of competency in public health on a master's level. In all three countries, interpersonal competencies, like team working and communication skills, are rated as highly important. However, employers in the UK and Poland generally rate public health specific competencies as much more important than their Dutch colleagues. It is concluded that while public health specific knowledge is providing a useful starting point for entry-level public health professionals, employers increasingly recognise the value of generic competencies such as communication and team working skills. The results suggest a stronger emphasis on teaching methods that encourage active learning and the integration of skills, which is crucial for enhancing graduates' employability, and foster an open attitude to multidisciplinary working, which is essential in modern health care.
Advances in Health Sciences Education 01/2007; 13(3):325-43. · 2.09 Impact Factor
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ABSTRACT: Outside the health care sector, consumer preferences have been effectively studied using rating and ranking conjoint techniques.
In the health care sector this technique has received less attention than its choice-based variant. Applications of rating
and ranking method to health care issues are few. This paper presents an application of rating conjoint analysis to study
the importance of quality, access and price to the health care consumers in Bulgaria. The paper first describes the rating
conjoint method and its distinctive features compared to the choice-based and the ranking approach. The method is illustrated
by the rating conjoint design applied in the study. Next, the impact of different quality-, access- and price-levels on the
rating of physician profiles is analysed and the differences between the socio-demographic groups are examined. The results
suggest that similar to other countries, the quality of care is a highly valued characteristic in Bulgaria, whereas access
is perceived as less important. The considerable importance of patient payments further implies that Bulgarians are responsive
to prices in the health care sector, especially the elderly, the village dwellers and the lowest income groups. The relevance
of the results with regards to health policy and planning, as well as with regards to the methodology of rating conjoint analysis
is discussed at the end of the paper.
Economics of Planning 08/2004; 37(3):267-286.
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ABSTRACT: An application of the contingent valuation method to the willingness and ability of Bulgarian consumers to pay for public health care services is presented. The study uses data from a household survey conducted in May-June 2000. The willingness and ability to pay for outpatient, inpatient and dental services is investigated. A combination of interval checklist and open-ended questions are used to elicit the willingness-to-pay amounts. The impact of the sociodemographic characteristics on the responses is examined by a generalized Tobit regression. Based on the regression equation, the welfare effects of various fee levels are simulated.
Applied Economics. 02/2004; 36(10):1117-1130.
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ABSTRACT: This paper analyses the attitudes towards patient payments in the Bulgarian public health care sector. The analysis is based on results of a household survey conducted in the region of Varna (the third largest city in Bulgaria) between May and June 2000. The data are collected through interviews based on a standardised questionnaire and are analysed by non-parametric statistical procedures. The results show that the majority of the respondents accept to pay for public health care services if these services are provided with good quality and quick access. On average, charges for primary and dental care receive higher approval than charges for hospital services. A large percentage of the sample disagrees with charges related to actual service cost or service quality and nearly all respondents consider a ceiling on payments appropriate. According to the majority of the interviewed, the charges should be retained at the place of service provision. The sample shows strong support for an extensive system of exemptions from payments.
Health Policy 02/2002; 59(1):1-24. · 1.51 Impact Factor
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ABSTRACT: One approach to the problem of low patient satisfaction in Bulgaria is to identify attributes of health care services that the consumers value most and to focus on their improvement. Based on data from a household survey, this paper examines the importance that health care consumers attach to quality, access and price. The survey was conducted in 2000 among the population of the region of Varna (the third largest city in Bulgaria). The elicitation of attribute importance was based on a self-explicated method. To analyse the data, an ordered logit regression was performed. The analysis shows that clinical quality is the most valued characteristic by Bulgarian health care consumers compared with social quality, access and price. Given the poor quality of health care provision in Bulgaria, the allocation of revenues to its improvement appears to be essential in order to raise patient satisfaction and to enhance social efficiency.
International Journal of Health Planning and Management 18(4):343-61. · 0.64 Impact Factor
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Economics of Education Review. 26(3):375-386.
