Discrete and portfolio choice experiments: Methodological considerations and health policy applications

The aim of this dissertation is to advance the literature on the elicitation of public preferences for health policies and, to this end, contains three more specific objectives. The first objective is to position a novel method, Participatory Value Evaluation (PVE), relative to other more commonly used multi-attribute preference-elicitation methods used in the health domain, like discrete choice experiments (DCEs). After a general introduction in Chapter 1, Chapter 2 introduces PVE in the health domain and, by comparing it conceptually to four established methods, aims to contribute to a well-informed selection of method for preference-elicitation by researchers and policymakers. The Chapter ends with recommendations for further development of PVE, in particular regarding the feasibility and validity of the method.

The second objective is to examine the influence of design characteristics of a DCE or PVE on the preferences elicited with the choice experiment, which is addressed in Chapters 3 and 6. Chapter 3 discusses the findings of a review of the literature across different domains on the impact of the presentation order of alternatives, attributes and choice sets on respondents’ choices in a DCE. Chapter 6 examines whether expenditure preferences and consequentiality perceptions of respondents in a PVE are sensitive to the payment vehicle used in the experiment and to the priming of opportunity costs. The third objective is to explore public preferences for health policy alternatives from a citizen perspective using DCE and PVE, which is addressed in Chapters 4 and 5. Chapter 4 uses a DCE to elicit public preferences for collective skin cancer prevention policies in Austria, the Netherlands, and Spain. Chapter 5 uses PVE to elicit public preferences for policy action regarding long-term care (LTC) for older people in the Netherlands in 2040.

Finally, Chapter 7 summarizes the main findings of Chapters 2 to 6 and discusses some strengths and limitations as well as several implications for future research and policy. In particular, the Chapter considers the validity of eliciting preferences for public policy from a citizen perspective and our current understanding of respondents’ choice processes and choice behaviours in PVE choice tasks.