Optimizing patient autonomy: a discrete choice experiment on preferences and disparities in healthcare provider selection

Background: In 2023, Israel introduced a legislative reform that, according to the Israeli Ministry of Health, aims to improve transparency and expand options for healthcare providers. This reform seeks to enhance patient choice, improve service quality and accessibility, foster competition and strengthen the public health system. The goals also include empowering patients to fully exercise their rights and make more informed healthcare decisions. Objectives: This study explores public preferences regarding hospital choice before the 2023 reform, evaluates the relative importance of key hospital attributes influencing decision-making, assuming a baseline of high-quality care and analyses how these preferences vary across demographic and socio-economic groups. Methods: Utilizing a discrete choice experiment involving 2117 participants, this study quantifies preferences for different hospital attributes, including hospital type, geographical location, and appointment availability. The study design incorporates attributes identified through a literature review and expert interviews, optimized to estimate trade-offs between attribute levels. Results: Findings indicate a strong preference for shorter waiting times and proximity to specialized services. Significant disparities emerge among respondents, particularly between those with public versus additional voluntary insurance coverage and across population groups (i.e. Arabs and Jews). A notable proportion of Arab respondents preferred the existing hospital choice regime over any suggested attribute combinations. Conclusions: While legislative reforms are designed to enhance patient involvement in decision-making, substantial gaps remain between policy intentions and actual public preferences. Although increased autonomy and choice empower patients, they can also introduce challenges, such as decision fatigue and the consumer paradox, potentially undermining reform effectiveness. Our findings underscore the need for more nuanced, patient-centred health policy approaches. Future research should focus on strategies that better address the diverse needs and preferences of the population, ultimately enhancing healthcare system efficiency and equity.