

@mastersthesis {6671,
	title = {Economic evaluation of complex, multidimensional health services: the case of palliative day care},
	year = {2003},
	note = {U184202},
	school = {University of London, London School of Hygiene and Tropical Medicine (United Kingdom)},
	type = {phdPh.{D}.},
	address = {Ann Arbor},
	abstract = {A study was undertaken using the EQ-5D instrument before and after a new palliative day care service was built and 140 subjects participated. Findings showed that the EQ-5D outcome instrument did not indicate any difference in outcome, supporting the hypothesis that no difference would be detected using this method. A choice experiment study was also undertaken in four PDC centres. This method can deconstruct a service into the constituent parts that are valued by users. It can measure the relative value of these attributes and may indicate willingness-to-pay if a price is also added. However, there were strong objections to this approach on theoretical as well as practical grounds. The attributes chosen for this study were: opening hours, access, specialist therapies; medical support; hairdressing and bathing. 79 patients took part in the study. No difficulties were reported in collecting data, despite their family and age. The results showed that specialist therapies were relatively more valued, and that hairdressing and bathing were not important in decision-making. Access to medical care was not as important as access to specialist therapies, and younger patients had higher preferences for services than older patients. The thesis critiques the use of health gain approaches for services that have a range of goals and aim to meet individuals{\textquoteright} specific needs. The choice experiment has provided insights into how services are valued cannot be derived from health gain approaches. It is not a complete picture since absolute values could not be estimated for comparison. But the data that has been produced a positive step along this road. For complex services, research will have to be more complex also. Research methods that can capture this complexity contribute understanding where none (or very little) may have previously existed.},
	keywords = {0573:Public health, Bibliographies, DXN079008, Health and environmental sciences, Psychology{\textendash}Abstracting, Public health, Statistics},
	url = {http://search.proquest.com/docview/301579029?accountid=14270},
	author = {Douglas, H R}
}
