Identification and evaluation of the factors that influencing the decision of Tehran citizens to enter to family practice, using a discrete choice experiment

Document Type : Research Paper


1 Ph.D in Economics, Tehran University

2 Professor of Economics, Tehran University


Despite the relative success of the health system and the promotion of health indicators over the last two decades, Iran's health system still faces serious problems. One of the most important of them, is the inequity in access to health. Theoretical studies and empirical evidences indicate that implementation of the referral system and family physician plan, is one of the main strategies to overcome inequity in the health and appropriate using of scarce resources in this area. In order to successful execution of the family physician, it is necessary, in addition to reform some known problems, the important factors influencing the decision of participants in the project have been identified by using scientific studies and methods and policy makers develop a package that is designed with maximum compliance to the preferences of the target population in order to increase the likelihood of successful implementation.This study is conducted for this purpose. The results indicate that,the visit,behavior of physician, the time of examination has been spent by doctor and being on call are attributes that influence the decision of citizens to enter to family physician. As we expected, increasing in visit, reduces the willingness to entrance to plan. The respectful behavior that given by the doctors, spending the appropriate time for patients and being On-call, increase the utility of citizens and the probability of their entrance to plan.The willingness to pay for behavior of physician,the time of examination and the attribute of On-call are estimated respectively 9579 , 9947 and 3750 Toman.


Adamowicz, W., Boxall, P., Williams, M. & Louviere, J. (1998). Stated preference Approaches for Measuring Passive Use Values: Choice Experiments and Contingent valuation, American Jornal of Agricaltureral Economics, 80(1): 64-75.
Alpizar, F. (2007). Using Choice Experiments for Non-Market Valuation, Transprot, 8(1).
Anderson, G., Hurst, J., Hussey, PS. & Jee-Hughes, M. (2000). Trends: health spending and out comes: trends in OECD countries 1960-1998, Health Aff, 19(3): 150-17.
Ben-Akiva, M. & Morikawa, T. (1990). Estimation of Switching Models from Revealed Preferences and Stated Intentions, Transportation Research Part A-Policy and Practice, 24(6): 485-495.
Bennett, J. & Adamowicz, V. (2001). Some Fundamental of Environmental Choice Modelling, in The Choice Modelling Approach to Environmental Valuation, edited by J. Bennett and R. Blamey. Cheltenham, UK: Edward Elgar.
Bryan, S., Buxton, M., Sheldon, R. & Grant, A. (1998). Magnetic resonance imaging for the investigation of knee injuries: an investigation of preferences, Health Economics, 7(7): 595-603.
Chen, T.T., Chung, H.P., Huang, H.C., Man, L.N. & Lai, M.S. (2010). Using discrete choice experiment to elicit doctors’ preferences for the report card design of diabetes care in Taiwan - a pilot study, Journal of Evaluation in Clinical Practice, 16(1): 14-20.
Cheraghi-Sohi, S., Hole, A.R., Mead, N., McDonald, R., Whalley, D., Bower, P. & Roland, M. (2008). What patients want from primary care consultations: a discrete choice experiment to identify patients' priorities, Ann Fam Med, 6(2): 107-115.
Coast, J., Flynn, T.N., Salisbury, C., Louviere, J. & Peters, T.J. (2006). Maximizing responses to discrete choice experiments: A randomized trial, Applied Health Economics and Health, 5(4): 249-260.
Freemantle, N. (1999). Does the UK National Health Service need a fourth hurdle for pharmaceutical reimbursement to encourage the more efficient prescribing of pharmaceuticals?, Health Policy, 46(3): 255-265.
Guyatt, G., Haynes, B.R., Jaeschke, R.Z., Cook, D.J., Green, L., Naylor, C.D., Wilson, M.C. & Richardson, W.S. (2000). Users’ guides to the medical literature: XXV, Evidence-based medicine: principles for applying the users’ guide to patient care, JAMA, 284(10): 1290-1296.
Hall, J., Viney, R., Haas, M. & Louviere, J. (2004). Using stated preference discrete choice modeling to evaluate health care programs, Journal of Business Research, 57, 1026-1032.
Hall, J. & Viney, R. (2000). The political economy of health sector reform, In: Bloom AL, editor, Health reform in Australia and New Zealand, Melbourne: Oxford Univ. Press, 39-53.
Hauber, A.B., Mohamed, A.F., Johnson, F.R. & Falvey, H. (2009). Treatment preferences and medication adherence of people with Type 2 diabetes using oral glucose-lowering agents, Diabetic medicine, 26(4): 416-424.
Hensher, D., Louviere, J. & Swait, J. (1999). Combining sources of preference data, Journal of Econometrics, 89(1-2): 197-221.
Hitchock, W., Mellon, M., Memran, M., Parasuraman, B., Ramachendran, S. & Walzer, S. (2007). Caregiver preferences for pediatric asthma treatment delivery system,Advances in Therapy, 24(6): 1240-1253.
Kjær, T. & Gyrd-Hansen, D. (2008). Preference heterogeneity and choice of cardiac rehabilitation program: Results from a discrete choice experiment, Health Policy, 85(1): 124-132.
Kleinman, L., McIntosh, E., Ryan, M., Schmier, J., Crawley, J., Locke, G.R. & De Lissovoy, G. (2002). Willingness to pay for Complete Symptom relief of Gastroesophagael Reflux Disease (GERD), Archives of Internal Medicine, 162(12): 1361-1366.
Lancaster, K.J. (1966). A new approach to consumer theory, Journal of Political Economy, 74(2): 132-157.
Lancsar, E.J., Hall, J.P., King, M., Kenny, P., Louviere, J., Fiebing, D.G., Hossain, I., Thien, F.C.K., Reddel, H.K. & Jenkins, CR. (2007). Using discrete choice experiments to investigate subject preferences for preventive asthma medication, Respirology, 12(1): 127-136.
Louviere, J., Hensher, D.A. & Swait, J. (2000). Stated Choice Methods, analysis and application, Cambride University Press, U.K.
Louviere, J.J. & Woodworth, G. (1983). Design and Analysis of Simulated Consumer Choice Or Allocation Experiments - An Approach Based on Aggregate Data, Journal of Marketing Research, 20(4): 350-367.
McFadden, D. (1974). Conditional logit analysis of qualitative choice behaviour, in Frontiers of Econometrics, P. Zarembka (ed.), Academic Press, London, U.K., 105-142.
McFadden, D. & Train, K. (2000). Mixed MNL models for discrete response, Journal of Applied Econometrics, 15, 447- 470.
Morgan, S. & Hurley, J. (2004). Influences on the health care technology cost driver, In: Forst, PG., McIntosh, T., Marchildon, G. (eds.), Selected discussion papers from the commission on the future of health care in Canada, University of Toronto Press, Toronto, 27-50.
Peter, A. & Berman, A. (2000). Decade of Health Sector Reform in Developing Countries: What Have We Learned?, Harvard School of Public Health, 15.
Ratcliffe, J., Buxton, M., McGarry, T., Sheldon, R. & Chanellor, J. (2004).Patients' preferences for characteristics associated with treatments for osteoarthritis, Reumatology, 43(3): 337-345.
Revelt, D. & Train, K. (1998). Mixed logit with repeated choices: households’ choices of appliance efficiency level, Review of Economics and Statistics, 80(4): 647-657.
Salkeld, G., Ryan, M. & Short, L. (2000). The veil of experience: do consumers prefer what they know best?, Health Economics, 9(3): 267-270.
Thurstone, L. (1927). A Law of Comparative Judgment, Psychological Review, 34, 273-286.
Train, K. (2003). Discrete choice methods with simulation, Cam-bridge University Press, UK.
Train, K.E. (1998). Recreation demand models with taste differences over people, Land Economics, 74(2): 230-239.
Van der Pol, M. & Cairns, J. (1998). Estabilishing patient preferences for blood transfusion support: an application or conjoint analysis, Health Serv Res Policy, 3(2): 70-76.
Viney, R., Lancasar, E. & Louviere, J. (2002). Discrete choice experiment to measure consumer preferences for health and health care, Expert Review of Pharmacoeconomics Outcomes Research, 2(4): 319-326.
Vojáček, O. & Pecáková, I. (2010). Comparison of discrete choice models for economic environmental research, Prague Economic Papers, 1, 35-53.
Walzer, S. & Zweifel, P. (2007). Willingness-to-pay for caregivers of children with asthma or wheezing conditions. Therapeutics and Clinical Risk Management, 3(1): 157-165.
Walzer, S. (2007). What do parents want from their child's asthma treatment? Therapeutics and Clinical Risk Management, 3(1): 167-175.
World Health Organisation (2002). The world health report.
  • Receive Date: 07 June 2014
  • Revise Date: 22 December 2014
  • Accept Date: 10 March 2015
  • First Publish Date: 22 June 2015