Willingness to Pay in Choosing Pre-hospital Emergency Services in Iran: A Population-Based Discrete Choice Experiment
-
Elham Ehsani-Chimeh
,
Leila Keikavoosi-Arani
,
Behzad Zohrevandi
,
Amirhossein Asghari
,
Enayatollah Homaie Rad
Abstract
Providing pre-hospital emergency services is accessible in Iran but costly for the country’s health system. This study calculated the willingness to pay (WTP) for pre-hospital emergency services in Iran. Discrete choice experiment (DCE) was used to measure the population’s WTP for ambulance services focusing on time, price, and quality of services. Four hundred and sixty people in Rasht city, Iran, participated in this online survey. Participants preferred lower transfer fees (β = -0.7, P˂ 0.05), lower time of reaching to the scene (β = -0.061, P˂ 0.05), lower time to arrive to the hospitals (β = -0.038, P ˂ 0.05), Private ambulance (β = -0.151, P ˂ 0.05), and emergency medical services (EMS) technicians (β = 0.209, P ˂ 0.05). Patients’ WTP in selecting EMS services can help policymakers to provide the best services.
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8. Aladdini K. EMS Response Time Models: A Case Study and Analysis for the Region of Waterloo [master thesis]. Ontario, Canada: University of Waterloo; 2010.
9. Akahane M, Tanabe S, Ogawa T, Koike S, Horiguchi H, Yasunaga H, et al. Characteristics and outcomes of pediatric out-of-hospital cardiac arrest by scholastic age category. Pediatr Crit Care Med. 2013;14(2):130-6. [PubMed ID:23314182]. https://doi.org/10.1097/ PCC.0b013e31827129b3.
10. Ogawa T, Akahane M, Koike S, Tanabe S, Mizoguchi T, Imamura T. Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study. BMJ. 2011;342:c7106. [PubMed ID:21273279]. https://doi.org/10.1136/bmj.c7106.
11. Chief O. [Number ON Iran’s EMS missions]. Tehran, Iran: Shabestan News Agency; 2019. [Cited:2023]. Persian. Available from: https://www.shabestan.news/. Ministry of Health and Medical Education. Number of Irans, EMS Msssions. Tehran Iran. Tasnim News Agency; 2023.[Cited: 2023]. Persian. Available from https://www.tasnimnews.com/fa/news/1402/01/05/2871691
12. Ito Y, Akahane M, Maeyashiki A, Ogawa T, Imamura T. Beneficiaries’ Willingness to Pay for Resuscitation Provided by Ambulance Attendants: A Survey Using the Contingent Valuation Approach. Health. 2017;09(10):1367-77. https://doi.org/10.4236/health.2017.910100.
13. Peyravi M, Ortenwal P, Djalali A, Khorram-Manesh A. An overview of shiraz emergency medical services, dispatch to treatment. Iran Red Crescent Med J. 2013;15(9):823-8. [PubMed ID:24616794]. [PubMed Central ID:PMC3929819]. https://doi.org/10.5812/ircmj.10982.
14. Narad RA, Driesbock KR. Regulation of ambulance response times in California. Prehosp Emerg Care. 1999;3(2):131-5. [PubMed ID:10225646]. https://doi.org/10.1080/10903129908958921.
15. Pons PT, Markovchick VJ. Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome? J Emerg Med. 2002;23(1):43-8. [PubMed ID:12217471]. https://doi.org/10.1016/s0736-4679(02)00460-2.
16. Solberg RG, Edwards BL, Chidester JP, Perina DG, Brady WJ, Williams MD. The prehospital and hospital costs of emergency care for frequent ED patients. Am J Emerg Med. 2016;34(3):459-63.[PubMed ID:26763824]. https://doi.org/10.1016/j.ajem.2015.11.066.
17. Danaf M, Becker F, Song X, Atasoy B, Ben-Akiva M. Online discrete choice models: Applications in personalized recommendations. Decis Support Syst. 2019;119:35-45. https://doi.org/10.1016/j.dss.2019.02.003.
18. Bose SK, Bream KD, Barg FK, Band RA. Willingness to pay for emergency referral transport in a developing setting: a geographically randomized study. Acad Emerg Med. 2012;19(7):793-800. [PubMed ID:22805629]. https://doi.org/10.1111/j.1553-2712.2012.01382.x.
19. Delgado-Lindeman M, Arellana J, Cantillo V. Willingness to pay functions for emergency ambulance services. J Choice Model. 2019;30:28-37. https://doi.org/10.1016/j.jocm.2018.12.001.
20. Bahadori M, Ravangard R. Determining and Prioritizing the Organizational Determinants of Emergency Medical Services (EMS) in Iran. Iran Red Crescent Med J. 2013;15(4):307-11. [PubMed ID:24083003]. [PubMed Central ID:PMC3785904]. https://doi.org/10.5812/ircmj.2192.
21. Nargesi DA, Hajizadeh M, Pakdel MJ, Gheysvandi E, Rad EH. Preferences of Iranians to select the emergency department physician at the time of service delivery. BMC Health Serv Res. 2021;21(1):1155. [PubMed ID:34696787]. [PubMed Central ID:PMC8547076]. https://doi.org/10.1186/s12913-021-07183-9.
22. Ehsani-Chimeh E, Sajadi HS, Majdzadeh R. Iran towards universal health coverage: The role of human resources for health. Med J Islam Repub Iran. 2018;32:100. [PubMed ID:30788334]. [PubMed Central ID:PMC6377005]. https://doi.org/10.14196/mjiri.32.100.
23. Mehrabian-Hassanloo N, Keikavoosi-Arani L. Effective Performance of Knowledge Management in Single-Specialty Cardiovascular Hospital. J Holist Nurs Midwifery. 2022;32(1):78-87. https://doi.org/10.32598/jhnm.32.1.2219.
24. Ellis RP, Martins B, Zhu W. Health care demand elasticities by typeof service. J Health Econ. 2017;55:232-43. [PubMed ID:28801131]. [PubMed Central ID:PMC5600717]. https://doi.org/10.1016/j.jhealeco.2017.07.007.
25. Alanazy ARM, Fraser J, Wark S. Organisational factors affectingemergency medical services’ performance in rural and urban areas of Saudi Arabia. BMC Health Serv Res. 2021;21(1):562. [PubMed ID:34098943]. [PubMed Central ID:PMC8183589]. https://doi.org/10.1186/s12913-021-06565-3.
26. Lee YJ, Shin SD, Lee EJ, Cho JS, Cha WC. Emergency Department Overcrowding and Ambulance Turnaround Time. PLoS One. 2015;10(6):e0130758. [PubMed ID:26115183]. [PubMed Central ID:PMC4482653]. https://doi.org/10.1371/journal.pone.0130758.
27. Nagata I, Abe T, Nakata Y, Tamiya N. Factors related to prolonged on-scene time during ambulance transportation for critical emergency patients in a big city in Japan: a population-based observational study. BMJ Open. 2016;6(1):e009599. [PubMed ID:26729386]. [PubMed Central ID:PMC4716242]. https://doi.org/10.1136/bmjopen-2015-009599.
28. Omidi M, Zohrevandi B, Homaie Rad E. From accident to hospital: measuring inequality in pre-hospital emergency services in a city in the North of Iran. Int J Human Rights Healthcare. 2021. https://doi.org/10.1108/ijhrh-05-2021-0121.
29. Jang WM, Lee J, Eun SJ, Yim J, Kim Y, Kwak MY. Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. PLoS One. 2021;16(5):e0251116. [PubMed ID:33939767]. [PubMed Central ID:PMC8092794]. https://doi.org/10.1371/journal.pone.0251116.
30. Arsenault C, Fournier P, Philibert A, Sissoko K, Coulibaly A, Tourigny C, et al. Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households. Bull World Health Organ. 2013;91(3):207-16. [PubMed ID:23476093]. [PubMed Central ID:PMC3590618]. https://doi.org/10.2471/BLT.12.108969.
31. Homaie Rad E, Delavari S, Aeenparast A, Afkar A, Farzadi F, Maftoon F. Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran. Korean J Fam Med. 2017;38(5):296-302. [PubMed ID:29026491]. [PubMed Central ID:PMC5637222]. https://doi.org/10.4082/kjfm.2017.38.5.296.
2. Emergency medical services in Iran. [The history of EMS in Iran]. Tehran, Iran: Emergency medical services in Iran; 2010. [Cited:2022]. Persian. Available from: http://www.115.ir/index.php/2019-07-10-10-29-36.
3. Wilson MH, Habig K, Wright C, Hughes A, Davies G, Imray CH. Pre-hospital emergency medicine. Lancet. 2015;386(10012):2526-34. [PubMed ID:26738719]. https://doi.org/10.1016/S0140-6736(15)00985-X.
4. Alanazy ARM, Wark S, Fraser J, Nagle A. Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review. Int J Environ Res Public Health. 2019;16(10). [PubMed ID:31100851]. [PubMed Central ID:PMC6572626]. https://doi.org/10.3390/ijerph16101728.
5. Burger A, Wnent J, Bohn A, Jantzen T, Brenner S, Lefering R, et al. The Effect of Ambulance Response Time on Survival
Following Out-of-Hospital Cardiac Arrest. Dtsch Arztebl Int. 2018;115(33-34):541-8. [PubMed ID:30189973]. [PubMed Central ID:PMC6156551]. https://doi.org/10.3238/arztebl.2018.0541.
6. Swan D, Baumstark L. Does Every Minute Really Count? Road Time as an Indicator for the Economic Value of Emergency Medical Services. Value Health. 2022;25(3):400-8. [PubMed ID:35227452]. https://doi.org/10.1016/j.jval.2021.09.009.
7. Sarlan A, Xiong FK, Ahmad R, Ahmad WFW, Bhattacharyya E. Pre-hospital emergency notification system. Nternational Symposium on Mathematical Sciences and Computing Research (iSMSC); Ipoh, Malaysia. IEEE; 2015. p. 168-73.
8. Aladdini K. EMS Response Time Models: A Case Study and Analysis for the Region of Waterloo [master thesis]. Ontario, Canada: University of Waterloo; 2010.
9. Akahane M, Tanabe S, Ogawa T, Koike S, Horiguchi H, Yasunaga H, et al. Characteristics and outcomes of pediatric out-of-hospital cardiac arrest by scholastic age category. Pediatr Crit Care Med. 2013;14(2):130-6. [PubMed ID:23314182]. https://doi.org/10.1097/ PCC.0b013e31827129b3.
10. Ogawa T, Akahane M, Koike S, Tanabe S, Mizoguchi T, Imamura T. Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study. BMJ. 2011;342:c7106. [PubMed ID:21273279]. https://doi.org/10.1136/bmj.c7106.
11. Chief O. [Number ON Iran’s EMS missions]. Tehran, Iran: Shabestan News Agency; 2019. [Cited:2023]. Persian. Available from: https://www.shabestan.news/. Ministry of Health and Medical Education. Number of Irans, EMS Msssions. Tehran Iran. Tasnim News Agency; 2023.[Cited: 2023]. Persian. Available from https://www.tasnimnews.com/fa/news/1402/01/05/2871691
12. Ito Y, Akahane M, Maeyashiki A, Ogawa T, Imamura T. Beneficiaries’ Willingness to Pay for Resuscitation Provided by Ambulance Attendants: A Survey Using the Contingent Valuation Approach. Health. 2017;09(10):1367-77. https://doi.org/10.4236/health.2017.910100.
13. Peyravi M, Ortenwal P, Djalali A, Khorram-Manesh A. An overview of shiraz emergency medical services, dispatch to treatment. Iran Red Crescent Med J. 2013;15(9):823-8. [PubMed ID:24616794]. [PubMed Central ID:PMC3929819]. https://doi.org/10.5812/ircmj.10982.
14. Narad RA, Driesbock KR. Regulation of ambulance response times in California. Prehosp Emerg Care. 1999;3(2):131-5. [PubMed ID:10225646]. https://doi.org/10.1080/10903129908958921.
15. Pons PT, Markovchick VJ. Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome? J Emerg Med. 2002;23(1):43-8. [PubMed ID:12217471]. https://doi.org/10.1016/s0736-4679(02)00460-2.
16. Solberg RG, Edwards BL, Chidester JP, Perina DG, Brady WJ, Williams MD. The prehospital and hospital costs of emergency care for frequent ED patients. Am J Emerg Med. 2016;34(3):459-63.[PubMed ID:26763824]. https://doi.org/10.1016/j.ajem.2015.11.066.
17. Danaf M, Becker F, Song X, Atasoy B, Ben-Akiva M. Online discrete choice models: Applications in personalized recommendations. Decis Support Syst. 2019;119:35-45. https://doi.org/10.1016/j.dss.2019.02.003.
18. Bose SK, Bream KD, Barg FK, Band RA. Willingness to pay for emergency referral transport in a developing setting: a geographically randomized study. Acad Emerg Med. 2012;19(7):793-800. [PubMed ID:22805629]. https://doi.org/10.1111/j.1553-2712.2012.01382.x.
19. Delgado-Lindeman M, Arellana J, Cantillo V. Willingness to pay functions for emergency ambulance services. J Choice Model. 2019;30:28-37. https://doi.org/10.1016/j.jocm.2018.12.001.
20. Bahadori M, Ravangard R. Determining and Prioritizing the Organizational Determinants of Emergency Medical Services (EMS) in Iran. Iran Red Crescent Med J. 2013;15(4):307-11. [PubMed ID:24083003]. [PubMed Central ID:PMC3785904]. https://doi.org/10.5812/ircmj.2192.
21. Nargesi DA, Hajizadeh M, Pakdel MJ, Gheysvandi E, Rad EH. Preferences of Iranians to select the emergency department physician at the time of service delivery. BMC Health Serv Res. 2021;21(1):1155. [PubMed ID:34696787]. [PubMed Central ID:PMC8547076]. https://doi.org/10.1186/s12913-021-07183-9.
22. Ehsani-Chimeh E, Sajadi HS, Majdzadeh R. Iran towards universal health coverage: The role of human resources for health. Med J Islam Repub Iran. 2018;32:100. [PubMed ID:30788334]. [PubMed Central ID:PMC6377005]. https://doi.org/10.14196/mjiri.32.100.
23. Mehrabian-Hassanloo N, Keikavoosi-Arani L. Effective Performance of Knowledge Management in Single-Specialty Cardiovascular Hospital. J Holist Nurs Midwifery. 2022;32(1):78-87. https://doi.org/10.32598/jhnm.32.1.2219.
24. Ellis RP, Martins B, Zhu W. Health care demand elasticities by typeof service. J Health Econ. 2017;55:232-43. [PubMed ID:28801131]. [PubMed Central ID:PMC5600717]. https://doi.org/10.1016/j.jhealeco.2017.07.007.
25. Alanazy ARM, Fraser J, Wark S. Organisational factors affectingemergency medical services’ performance in rural and urban areas of Saudi Arabia. BMC Health Serv Res. 2021;21(1):562. [PubMed ID:34098943]. [PubMed Central ID:PMC8183589]. https://doi.org/10.1186/s12913-021-06565-3.
26. Lee YJ, Shin SD, Lee EJ, Cho JS, Cha WC. Emergency Department Overcrowding and Ambulance Turnaround Time. PLoS One. 2015;10(6):e0130758. [PubMed ID:26115183]. [PubMed Central ID:PMC4482653]. https://doi.org/10.1371/journal.pone.0130758.
27. Nagata I, Abe T, Nakata Y, Tamiya N. Factors related to prolonged on-scene time during ambulance transportation for critical emergency patients in a big city in Japan: a population-based observational study. BMJ Open. 2016;6(1):e009599. [PubMed ID:26729386]. [PubMed Central ID:PMC4716242]. https://doi.org/10.1136/bmjopen-2015-009599.
28. Omidi M, Zohrevandi B, Homaie Rad E. From accident to hospital: measuring inequality in pre-hospital emergency services in a city in the North of Iran. Int J Human Rights Healthcare. 2021. https://doi.org/10.1108/ijhrh-05-2021-0121.
29. Jang WM, Lee J, Eun SJ, Yim J, Kim Y, Kwak MY. Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. PLoS One. 2021;16(5):e0251116. [PubMed ID:33939767]. [PubMed Central ID:PMC8092794]. https://doi.org/10.1371/journal.pone.0251116.
30. Arsenault C, Fournier P, Philibert A, Sissoko K, Coulibaly A, Tourigny C, et al. Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households. Bull World Health Organ. 2013;91(3):207-16. [PubMed ID:23476093]. [PubMed Central ID:PMC3590618]. https://doi.org/10.2471/BLT.12.108969.
31. Homaie Rad E, Delavari S, Aeenparast A, Afkar A, Farzadi F, Maftoon F. Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran. Korean J Fam Med. 2017;38(5):296-302. [PubMed ID:29026491]. [PubMed Central ID:PMC5637222]. https://doi.org/10.4082/kjfm.2017.38.5.296.
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| Issue | Vol 8 No 2 (2024) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v8i2.15629 | |
| Keywords | ||
| Ambulance Pre-hospital Emergency Preferences Willingness to Pay (WTP) Discrete Choice Experiment Iran | ||
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How to Cite
1.
Ehsani-Chimeh E, Keikavoosi-Arani L, Zohrevandi B, Asghari A, Homaie Rad E. Willingness to Pay in Choosing Pre-hospital Emergency Services in Iran: A Population-Based Discrete Choice Experiment. Health Tech Ass Act. 2024;8(2).
