Characteristics of Integrated Care Programmes and their Impact on Patient Benefit: A Discrete-Choice Experiment for Integrated Care Networks

Purpose: Innovative care models shall reduce the frictional losses in health-care. The successful implementation of care networks requires the acceptance by the health care providers, by the patients and citizens as well as by the payers. The consideration of preferences is an essential factor for success. The aim of this study is to analyse patient preferences. Methods: With the help of Discrete-Choice experiment 21 patient-relevant attributes of innovative healthcare programmes were examined. On the basis of a balanced overlapping design (sawtooth) a total of 140 choice sets with the highest possible D efficiency was generated. The 21 attributes were divided into 4 thematic priorities for analysis. The cost attribute was integrated as a uniform comparator. The evaluation was done by a random effects logit estimation (STATA). Results: The representative samples (N=1322) revealed that in all 4 DCE blocks the attribute additional costs had the strongest influence on the patients choice (1: coeff.; 1.047; 2: coeff.: 1.105; 3.: coeff.: 0.956; 4.: coeff.: 0.954). This was followed by medical apparatus and facilities, waiting time for an appointment, professional experience, travelling time to treatment site, and exchange of clinical information. Transfer management and consideration of individual circumstances for example, had a small influence on patient choice. Conclusion: In order to increase the acceptance of innovative health-care programmes preferences must be known and integrated into the design of the services. The present study has attempted to depict the patients' perspectives towards the new care systems. The individual selection decisions were not, as would be expected, influenced by the innovative approaches such as case management or shared decision making but rather by the quality of the infrastructure, the waiting times and professional experience.