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Original Investigation
March 2017

Contingent Valuation Analysis of an Otolaryngology and Ophthalmology Emergency Department: The Value of Acute Specialty Care

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
  • 2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
  • 3Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
  • 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2017;143(3):234-238. doi:10.1001/jamaoto.2016.3267
Key Points

Question  What is the value of acute specialty care, as assessed by a contingent valuation analysis of a specialty emergency department?

Findings  In this survey study, patients presenting to the emergency department with eye and ear, nose, and throat complaints placed an increased explicit value on specialty emergency services, relative to general emergency care.

Meaning  Contingent valuation data are useful in valuing patient preferences in monetary terms and can help inform state-wide resource allocation and the availability of direct-to-specialist care.

Abstract

Importance  Specialty emergency departments (EDs) provide a unique mechanism of health care delivery, but the value that they add to the medical system is not known. Evaluation of patient preferences to determine value can have a direct impact on resource allocation and direct-to-specialist care.

Objective  To assess the feasibility of contingent valuation (CV) methodology using a willingness-to-pay (WTP) survey to evaluate specialty emergency services, in the context of an ophthalmology- and otolaryngology-specific ED.

Design, Setting, and Participants  Contingent valuation analysis of a standalone otolaryngology and ophthalmology ED. Participants were English-speaking adults presenting to a dedicated otolaryngology and ophthalmology ED. The WTP questions were assessed using a payment card format, with reference to an alternative modality of treatment (ie, general ED), and were analyzed with multivariate regression.

Intervention  Validated WTP survey administered from October 14, 2014, through October 1, 2015.

Main Outcomes and Measures  Sociodemographic data, level of distress, referral data, income, and WTP.

Results  A total of 327 of 423 (77.3%) ED patients responded to the WTP survey, with 116 ophthalmology and 211 otolaryngology patients included (52.3% female; mean [range] age, 46 [18-90] years). The most common reason for seeking care at this facility was a reputation for specialty care for both ear, nose, and throat (80 [37.9%]) and ophthalmology (43 [37.1%]). Mean WTP for specialty-specific ED services was $377 for ophthalmology patients, and $321 for otolaryngology patients ($340 overall; 95% CI, $294 to $386), without significant difference between groups (absolute difference, $56; 95% CI, $−156 to $43). Self-reported level of distress was higher among ear, nose, and throat vs ophthalmology patients (absolute difference, 0.47 on a Likert scale of 1-7; 95% CI, 0.10 to 0.84). Neither level of distress, income, nor demographic characteristics influenced WTP, but patients with higher estimates of total visit cost were more likely to have higher WTP (β coefficient, 0.27; SE, 0.05; adjusted R2 = 0.17 for model).

Conclusions and Relevance  Patients with eye and ear, nose, and throat complaints place a mean explicit value on specialty emergency services of $340 per visit, relative to general emergency care. Ultimately, CV data using WTP methodology are useful in valuing patient preferences in monetary terms and can help inform state-wide resource allocation and the availability of direct-to-specialist care.

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