The effect of out-of-pocket costs and financial rewards in a discrete choice experiment: an application to lifestyle programs

BMC Public Health

Mattijs S Lambooij²  Paul F van Gils²  Huberta E Hart¹  G Ardine de Wit³  Jorien Veldwijk³  Johanna O P Wanders² 

[1] Leidsche Rijn Julius Health Care Centers, Eerste Oosterparklaan 78, 3544 AK Utrecht, The Netherlands;National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, PO Box 1 (Internal postal code: 101), 3720 BA Bilthoven, The Netherlands;Division: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, Postbus 85500, 3508 GA Utrecht, The Netherlands

关键词: Diabetes mellitus type 2;    Willingness to participate;    Discrete choice experiment;    Lifestyle programs;    Financial rewards;    Out-of-pocket costs;   

Others  :  1128246
DOI  :  10.1186/1471-2458-14-870

 received in 2014-02-18, accepted in 2014-08-18,  发布年份 2014

【 摘 要 】

Background

Both out-of-pocket costs and financial rewards can be used to influence health related behavior. However, it is unclear which of these two has a larger effect on health related behavior. The aim of this study was to explore the possible difference in effect size between out-of-pocket costs and financial rewards on the willingness of diabetes mellitus type 2 (DM2) patients to participate in a lifestyle program.

Methods

A discrete choice experiment (DCE) questionnaire was sent to 767 DM2 patients in a geographically defined area (De Leidsche Rijn, Utrecht) in The Netherlands and completed by 206 of them. The questionnaire comprised of 18 choice tasks of which 9 contained a financial reward for lifestyle program completion, while the other 9 included out-of-pocket costs for program participation. In a second version of the questionnaire, the order of out-of-pocket cost and financial reward choice tasks was counterbalanced to reduce bias with respect to the position (first or second) of the two types of choice tasks. Panel-mixed-multinomial-logit models were used for data analysis.

Results

Increasing out-of-pocket costs were associated with a decreasing willingness to participate in a lifestyle program and, contrary to our expectations, increasing financial rewards were also associated with a decreasing willingness to participate in a lifestyle program. In addition, this willingness to participate changed to the same extent for both increasing out-of-pocket costs and increasing financial rewards.

Conclusions

As expected, increasing out-of-pocket costs may prevent people from deciding to participate in a lifestyle program. However, offering a financial reward to persuade people to participate in a lifestyle program, may result in decreasing willingness to participate in a lifestyle program as well.

【 授权许可】

   
2014 Wanders et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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