آزمایش انتخاب گسسته، رویکردی کارا در ارزشگذاری اقتصادی منافع پروژهها و سیاستهای سلامت

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دکتری اقتصاد، دانشکده اقتصاد، دانشگاه تهران

2 دانشیار دانشکده اقتصاد، دانشگاه تهران

3 استاد دانشکده اقتصاد، دانشگاه تهران

4 عضو هیات علمی مرکز پژوهش های مجلس

چکیده

امروزه یکی از آموزههای سیاستگذاری در حوزههای گوناگون، توصیه به شناخت ترجیحات جامعه هدف ازسوی سیاستگذار است. در حوزه سلامت طراحی کارا و مؤثر سیاستها و ارائه خدمات بهداشتی، نیازمند وجود انطباق میان اهداف آنها با خواستههای جامعه است که این خود مستلزم آگاهی سیاستگذاران سلامت، از ترجیحات افراد درخصوص برنامههای سلامت و دستاوردهای آن است.
مطالعات نظری نشان میدهد، یکی از بهترین روشها جهت شناسایی ترجیحات افراد جامعه و ارزشگذاری منافع سیاستها، آزمایش انتخاب گسسته است. با توجه به عدم شناخت کافی ازاینرویکرد در مطالعات داخلی و مغفول واقع شدن کاربرد آن در حوزه سیاستگذاری سلامت در کشور، در این مقاله سعی شده است دلایل اهمیت استفاده از آزمایش انتخاب گسسته در حوزه سلامت بیان شود و پس از تبیین مبانی نظری و متدولوژی بهکارگرفته شده در این رویکرد، کارکردهای گوناگون آن در این حوزه ارائه شود.
با توجه به کارکردهای آزمایش انتخاب گسسته و ازآنجاکه در ابتدای اجرای طرح پزشک خانواده قرار داریم، بهنظر نگارندگان این مقاله، یکی از الزامات و پیشنیازهای اجرای موفق طرح پزشک خانواده در کشور، آگاهی پیدا کردن نسبت به مؤلفههای اثرگذار بر تصمیم پزشکان عمومی برای ورود به این طرح ازیکطرف و ازطرفدیگر شناخت عوامل مؤثر بر تصمیم شهروندان در انتخاب پزشک خانواده خود است. وجود چنین شناختی و لحاظ آن در نحوه پیادهسازی طرح، در کنار تمهید سایر بسترهای لازم همچون منابع مالی و زیرساختهای لازم، احتمال اجرای موفقیتآمیز طرح را بهطور چشمگیری افزایش میدهد.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Discrete Choice Experiment, an Efficient Approach to Economic Valuation of Benefits in Health Projects and Policies

نویسندگان [English]

  • Seyed Mohammad Hadi Sobhanian 1
  • Jafar Ebadi 2
  • Mohsen Mehrara 3
  • Ali Akhavan Behbahani 4
1
2
3
4
چکیده [English]

Today, one of the approaches that in various domains such as health care policy is adopted, is that decision makers in the process of making and implementation of policies, try as far as possible, to consider the preferences and desires of the target population. Therefore, efficient and effective policy design and delivery of health services requires adaptation of their goals to the preferences of the society, which needs knowledge of health policy makers about population’s preferences and their valuation of health programs.
Discrete choice experiment(DCE) is one of the best ways to identify the preferences of the population and valuation of outcomes. Because of little knowledge about this approach in iran and limited application of DCE in internal studies especially in the field of health policy, in this paper we emphasis on the reasons of the importance of using a DCE in the health economics and their theorical foundations and applications.
We believe that, one of the requirements and prerequisites to successful implementation of the family physician in iran, is the knowledge of policy makers about preferences and desires of participants in this program, i.e. GPs and citizens. Such knowledge, along with other necessary conditions, such as Financing and provision of necessary infrastructure, significantly increases the probability of successful implementation of the scheme.

کلیدواژه‌ها [English]

  • Economic Valuation
  • Preferences of Consumer
  • Discrete Choice Modeling

مراجع

  1. سبحانیان، سیدمحمدهادی (1393). «شناسایی و ارزشگذاری ترجیحات مشارکتکنندگان در طرح پزشک خانواده، با استفاده از رویکرد آزمایش انتخاب گسسته»، مطالعه موردی شهر تهران، دانشکده اقتصاد، دانشگاه تهران.
  2. عباسزاده، نصرتا... (1391). ارزش اقتصادی امنیت عرضه برق در ایران، دانشکده اقتصاد، دانشگاه تهران.
  3. قربانی، محمد و علی فیروز زارع (1376). مقدمهای بر ارزشگذاری محیط زیست، دانشگاه فردوسی مشهد.
  4. مهرآرا، محسن (1387). اقتصاد سلامت، تهران، دانشگاه تهران.
  5. Aspinall, P.A., Z.K. Johnson, A. Azuara-Blanco, A. Montarzino, R. Brice, A. Vickers (2008). "Evaluation of Quality of life and Priorities of Patients with Glaucoma", Investigative Ophthalmology Visual Science, Vol. 49, No.5.
  6. Bateman, I. J., R. T. Carson, B. Day, M. Hanemann, N. Hanley, T. Hett, M. Jones-Lee, G. Loomes, S. Mourato, E. Özdemiroglu, D. Pearce, J. Sugden and J. Swanson (2002). Economic Evaluation with Stated Preference Techniques, A Maunal, 1 edn, Edward Elgar Publishing Limited, Cheltenham.
  7. Bech, M. (2003). "Politicians' and Hospital Managers' Trade-offs in the Choice of Reimbursementscheme: A Discrete Choice Experiment", Health Policy, Vol. 66, No. 3.
  8. Blamey, R. K., J. W. Bennett, J. J. Louviere, M. D. Morrison and J. Rolfe (2000). "A Test of Policy Labels in Environmental Choice Modelling Studies", Ecological Economics, Vol. 32, No. 2.
  9. Boardman, A. E., D. H. Greenberg, A. R. Vining and B. A. Weisbrod (2001). Cost-Benefit Analysis, 2 edn, Printice Hall, Upper Saddle River, New Jersey.
  10. Bryan, S., M. Buxton, R. Sheldon and A. Grant (1998). "Magnetic Resonance Imaging for the Investigation of Knee Injuries: An Investigation of Preferences", Health Economics, Vol. 7, No. 7.
  11. Cairns, J. and M. Van der Pol (1997). "Saving Future Lives. A Comparison of Three Discoutning Models", Health Economics, Vol. 6, No. 4.
  12. Carlsson, F. and P. Martinsson (2003). "Design Techniques for Stated Preference Methods in Health Economics", Health Economics, Vol. 12, No. 4.
  13. Clark M., D. Moro, A. Szczepura (2011). "Balancing Patient Preferences and Clinical Needs: Community Versus Hospital Based Care for Patients with Suspected DVT", Health Policy, Vol. 90, No.2-3.
  14. Farrar, S., M. Ryan, D. Ross and A. Ludbrook (2000). "Using Discrete Choice Modelling in Priority Setting: an Application to Clinical Service Developments", Social Science and Medicine, Vol. 50, No. 1.
  15. Fraenkel, L., F. Constantinescu, M. Oberto-Medina, DR. Wittink (2005). "Women's Preferences for Prevention of Bone Loss". J Rheumatol, Vol. 32, No.6.
  16. Freeman, A. M. (1999). The Measurement of Enviromental and Resource Values, 3 edn, Resources for the Future, Washington, DC.
  17. Garrod, G. and K. Willis (1999). Economic Valuation of the Environment, Methods and Case Studies Edward Elgar Publishing Limited, Cheltenham UK.
  18. Green C., K. Gerard (2009). "Exploring the Social Value of Health-Care Interventions: A Stated Preference Discrete Choice Experiment", Health Econ, Vol. 18, No.8.
  19. Green, P. E. and V. Srinivasan (1978). "Conjoint Analysis in Consumer Research - Issues and Outlook 2", Journal of Consumer Research, Vol. 5, No. 2.
  20. Gyrd-Hansen, D. and U. Slothuus (2002). "The Citizen's Preferences for Financing Public Health Care: a Danish Survey", In T. J. Health Care Finance Econ., Vol. 2, No. 1.
  21. Hall, J., P. Kenny, M. King, J. Louviere, R. Viney and A. Yeoh (2002). "Using Stated Preference Discrete Choice Modelling to Evaluate the Introduction of Varicella Vaccination", Health Economics, Vol. 11, No. 5.
  22. Hanley, N. and C. L. Spach (1993). Cost-Benefit Analysis and the Environment, Edward Elgar.
  23. Haughney, J., M. Fletcher, S. Wolfe, J. Ratcliffe, R. Brice, MR. Partridge (2008). "Features of Asthma Management: Quantifying the Patient Perspective", BMC Pulm Med. Vol. 6.
  24. Hensher, D.A., J.M. Rose, W.H. Greene (2005). Applied Choice Analysis: a Primer. Cambridge, Cambridge University Press.
  25. Hidona, N. (2002). The Economic Valuation of the Environment and Public Policy - A Hedonic Approach Edward Elgar Publishing Limited, Cheltenham, UK.
  26. Johnson, F. R., W. H. Desvousges, M. C. Ruby, D. Stieb and De P. Civita (1998). "Eliciting Stated Health Preferences: An Application to Willingness to Pay for Longevity", Medical Decision Making, Vol. 18, No. 2.
  27. Kjaer T. (2005). "A Review of the Discrete Choice Experiment", Working Paper, University of Southern Denmark.
  28. Lee, WC., A.V. Joshi, S. Woolford, M. Sumner, M. Brown, N. Hadker, CL. Pashos (2008). "Physicians' Preferences Towards Coagulation Factor Concentrates in the Treatment of Haemophilia With Inhibitors: a Discrete Choice Experiment",  Haemophila, Vol. 14, No. 3.
  29. Longworth, L., J. Ratcliffe, M. Boulton (2001). "Investigating Women's Preferences for Intrapartum Care: Home Versus Hospital Births", Health and Social Care in Community, Vol. 9, No. 6.
  30. Louviere, J. (2000). "Why Stated Preference Discrete Chioice Modelling is Not Conjoint Analysis", Memetrics White Paper.
  31. Louviere, J. J. and G. Woodworth (1983). "Design and Analysis of Simulated Consumer Choice or Allocation Experiments - An Approach Based on Aggregate Data", Journal of Marketing Research, Vol. 20, No. 4.
  32. Louviere, J., D. A. Hensher, and J. Swait  (2000). Stated Choice Methods, Analysis and Application Cambride University Press, U.K.
  33. Luce, R. D. and J. W. Tukey (1964). "Simultaneous Conjoint-Measurement- A New Type of Fundamental Measurement", Journal of Mathematical Psychology, Vol. 1, No. 1.
  34. Maddala, T., K. A. Phillips and F. R. Johnson (2003). "An Experiment on Simplifying Conjointanalysis Designs for Measuring Preferences", Health Economics, Vol. 12, No. 12.
  35. Manski, C. H. (1977). "The Structure of Random Utility Models", Theory and Decision, Vol. 8.
  36. Mark, T. L. and J. Swait (2004). "Using Stated Preference and Revealed Preference Modeling to Evaluate Prescribing Decisions", Health Economics, Vol. 13, No. 6.
  37. McFadden, D. (1974). "Conditional Logit Analysis of Qualitative Choice Behaviour", in Frontiers of Econometrics, P. Zarembka, ed., Academic Press, London, U.K.,.
  38. _______ (1980). "Econometric Models for Probabilistic Choice Among Products", The Journal of Business, Vol. 53, No. 3, England.
  39. Papanikolaou, P., P. Lyne, J. Ratcliffe (2007). Using the Discrete Choice Experimental Design to Investigate Decision-Making about Pressure Ulcer Prevention by Community Nurses, Health Soc Care Community, Vol. 15, No. 6.
  40. Ratcliffe, J., H.L. Bekker, P. Dolan, R. Edlin (2009). Examining Theattitudes and Preferences of Health Care Decision- Makers in Relation to Access, Equity and cost-Effectiveness: A Discrete Choice Experiment, Health Policy, Vol. 90, No.1.
  41. Ratcliffe, J., M. Buxton, T. McGarry, R. Sheldon, J. Chanellor (2004). "Patients' Preferences for Characteristics Associated with Treatment for Osteoarthritis", Reumatology, Vol. 43, No. 3.
  42. Roux, L., C. Ubach, C. Donaldson, M. Ryan (2004). "Valuing the Benefits of Weight loss Programs: an Application of The Discrete Choice Experiment", OBESITY RESEARC, Vol. 12, No. 8.
  43. Ryan, M., K. Gerard, M. Amaya-Amaya (2008). "Using Discrete Choice Experiments to Value Health and Health Care, The Economic of Non-Market Goods and Resources Springer, Vol. 11.
  44. Salkeld, G., M. Solomon, L. Short, M. Ryan and J. E. Ward (2003). "Evidence-based Consumer Choice: A Case Study in Colorectal Cancer Screening", Public Health, Vol. 27, No. 4.
  45. Scott, A. (2001). "Eliciting GPs' Preferences for Pecuniary and Non- pecuniary Job Characteristics", Journal of Health Economics, Vol. 20, No. 3.
  46. Scott, A., M. S. Watson and S. Ross (2003). "Eliciting Preferences of the Community for out of Hours Care Provided by General Practitioners: A Stated Preference Discrete Choice Experiment", Social Science Medicine, Vol. 56, No. 4.
  47. Seston, E. M., DM. Ashcroft, C.E. Griffiths (2008). "Balancing the Benefits and Risks of Drug Treatment: A Stated-Preference, Discrete Choice Experiment with Patients with Psoriasis", Arch Dermatol, Vol. 143, No. 9.
  48. Seston, E.M., R.A. Elliott, P.R. Noyce, K. Payne (2007). "Women's Preferences for the Provision of Emergency Hormonal Contraception Services", Pharm World Sci., 29 (3).
  49. Skjoldborg, U. S. and D. Gyrd-Hansen (2003). "Conjoint Analysis. The Cost Variable: An Achilles' heel?", Health Economics, Vol. 12, No. 6.
  50. Tappenden, P., J. Brazier, J. Ratcliffe, J. Chilcott (2007). "A Stated Preference binary Choice Experiment to Explore NICE Decision Making", Pharmacoeconomics, Vol. 25, No.8.
  51. Thurstone, L. L. (1927). "A Law of Comparative Judgment", Psychological Review, Vol. 34.
  52. Train, K. (2003). Discrete Choice Methods with Simulation Cambridge University Press, U.K.
  53. Ubach, C., A. Scott, F. French, M. Awramenko and G. Needham (2003). "What do Hospital Consultants Value about Their Jobs? A discrete Choice Experiment", BMJ, Vol. 326, No. 7404.
  54. Watson, V., M. Ryan, E. Watson (2009). "Valuing Experience Factors in the Provision of Chlamydia Screening: An Application to Women Attending the Family Planning Clinic", Value in Health, Vol.12, No.4.

فایل ها

هم رسانی

ارجاع به این مقاله

آمار