Exploring what lies behind public preferences for avoiding health losses caused by lapses in healthcare safety and patient lifestyle choices

© 2013 Singh et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Although many studies have identified public preferences for prioritising health care interventions based on characteristics of recipient or care, very few of them have examined the reasons for the stated preferences. We conducted an on-line person trade-off (PTO) study (N=1030) to investigate whether the public attach a premium to the avoidance of ill health associated with alternative types of responsibilities: lapses in healthcare safety, those caused by individual action or lifestyle choice; or genetic conditions. We found that the public gave higher priority to prevention of harm in a hospital setting such as preventing hospital associated infections than genetic disorder but drug administration errors were valued similar to genetic disorders. Prevention of staff injuries, lifestyle diseases and sports injuries, were given lower priority. In this paper we aim to understand the reasoning behind the responses by analysing comments provided by respondents to the PTO questions. Method: A majority of the respondents who participated in the survey provided brief comments explaining preferences in free text responses following PTO questions. This qualitative data was transformed into explicit codes conveying similar meanings. An overall coding framework was developed and a reliability test was carried out. Recurrent patterns were identified in each preference group. Comments which challenged the assumptions of hypothetical scenarios were also investigated. Results: NHS causation of illness and a duty of care were the most cited reasons to prioritise lapses in healthcare safety. Personal responsibility dominated responses for lifestyle related contexts, and many respondents mentioned that health loss was the result of the individual’s choice to engage in risky behaviour. A small proportion of responses questioned the assumptions underlying the PTO questions. However excluding these from the main analysis did not affect the conclusions. Conclusion: Although some responses indicated misunderstanding or rejection of assumptions we put forward, the results were still robust. The reasons put forward for responses differed between comparisons but responsibility was the most frequently cited. Most preference elicitation studies only focus on eliciting numerical valuations but allowing for qualitative data can augment understanding of preferences as well as verifying results.EPSRC through the MATCH programme(EP/F063822/1 and EP/G012393/1) and HERG within Brunel University

Does customer satisfaction predict customer demand in the rail sector?

Accent was commissioned by the Association of Train Operating Companies to examine to what extent a relationship between customer satisfaction and customer demand can be determined, both generally to set out a broad industrial context and specifically within the rail sector. The research programme comprised a literature review coupled with a small number of depth interviews with practitioners to draw on their expertise. Our key findings were reported and discussed extensively within the industry. Some of the aspects explored comprised: • Although one would expect that there would be a link between satisfaction and demand, the literature review explored the role of four mediating factors: 1) length of relationship, 2) costs of switching, 3) price of the product/service, and 4) presence and price of available substitutes. • Does recency of experience matter? Our research programme drew some interesting conclusions in this respect • We then explored whether any particular type of customer satisfaction appeared to have greater influence on demand? • We looked to see whether negative customer satisfaction had more impact on demand than positive satisfaction? • Lastly, we looked to determine what drives demand and what is the role of satisfaction within the product/service demand process? Once a number of hypotheses had been developed through the literature review we used the depth interviews with senior contacts responsible for producing/analysing satisfaction data in a variety of industries. Our key findings there were that: - most companies used the net promoter score - key factors driving demand rather than satisfaction were brand strength, competitive pricing, and high profile marketing. Overall, our conclusion was that satisfaction has a greater role in driving performance rather than predicting demand. The paper will set out all the arguments that allowed the team come to some very illuminating conclusions for the industry

Consistency and fungibility of monetary valuations in transport: an empirical analysis of framing and mental accounting effects

Governments around the world use monetised values of transport externalities to undertake project appraisal and cost–benefit analysis. However, because different types of benefits are monetised (e.g., travel time savings, preventing statistical fatalities, reliability, etc.) the question naturally arises as to whether they are consistent. That is, whether a “dollar is a dollar” as welfare economics requires, or whether spending money in one area carries a different disutility from spending money in another area. This would equate to a violation of fungibility, which is the property of a good or a commodity whose individual units are capable of mutual substitution. The view that money is not fungible is explained in behavioural economics through theories of framing and mental accounting. This paper describes the results of a stated choice experiment designed to test the fungibility and consistency of monetary valuations in transport. From a nationally representative sample, we elicit direct values for the three pairwise trade-offs between travel time, travel cost, and safety. We then show that in the context of our analysis, any trade-offs inferred on the basis of other trade-offs, as is common practice (e.g. inferring a safety vs time trade-off on the basis of monetary valuations for time and safety), produces biased results, suggesting that the assumption of fungibility does not hold. Specifically, we find that time is valued more highly when valued directly by cost than when traded with safety, and the reverse is true for safety