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High quality healthcare is important to all patients. If healthcare is felt to be high quality, then patients will be satisfied, and the relationship between patients and healthcare providers will improve. Patient satisfaction is among the most commonly used service quality indicators; however, it is not fully known which factors influence satisfaction. Therefore, it is necessary to pay attention to the elements that affect both healthcare quality and patient satisfaction. Nowadays, several methods are used in health economics to assess patient preferences, prioritize them and help health policy makers improve services. Discrete choice experiment (DCE) is one method that is useful to elicit patient preferences regarding healthcare services. The purpose of this paper is to apply DCE and elicit patient preferences in medical centers to rank certain healthcare quality factors.

The descriptive, analytical study used a cross-sectional questionnaire that the authors developed. In total, 12 scenarios were chosen after applying fractional factorials. The questionnaire was completed by patients who were admitted to Kerman General Teaching Hospitals, South-East Iran in 2015. Patient preferences were identified by calculating the characteristics’ marginal effects and prioritizing them. The generalized estimation equation (GEE) model was used to determine attribute effects on patient preferences.

In total, 167 patients completed the questionnaire. Prioritizing the attributes showed that “physical examination” was the most important attribute. Other key features included “cleanliness,” “training after discharging,” “medical staff attention,” “waiting for admission” and “staff attitude.” All attributes were statistically significant (p<0.05) except staff behavior. No demographic characteristic was significant.

To increase hospital patient satisfaction, health policy makers should develop programs to enhance healthcare quality and hospital safety by increasing physical examination quality and other services.

To estimate DCE independent variables, logistic regression models are usually used. The authors used the GEE model to estimate discrete choice experiment owing the explanatory variables’ dependency.

Reducing health inequalities between the poor and the rich is one of the challenges that the Iranian healthcare sector is facing. One of the goals of the Iranian Government in the Healthcare Sector Evolution Plan (HSEP) is claimed to be creating an opportunity for the poor to use inexpensive services. The purpose of this paper is to provide an analysis of the status of the poor in the HSEP. Based on this evaluation, the authors will provide policy recommendations to improve the benefits of the HSEP for the poor people.

This paper is based on a qualitative study conducted in 2017. The research sample includes policymakers, experts and scholars at the macro-level of the Iranian healthcare system who were well-aware of the financial support for the poor. Overall, 35 semi-structured interviews were carried out. Data were analyzed based on the thematic analysis method.

The effects of the HSEP on the poor were studied in terms of their positive outcomes and challenges. Despite the achievements of the HSEP for all people, the most important challenge was the lack of targeted state subsidies for the poor. These subsidies should have included free insurance coverage, reducing inpatient payment and allocation of a separate budget for the poor.

Adopting some policies to target public health subsidies toward the poor such as free insurance specific for the poor (based on means testing), as well as user fee exemption and waivers could improve access to health services for them in Iran. In addition, separate funding for such policies, strengthening health prevention and health care services for marginalized populations, and improving their health literacy could help ensure the poor’s benefiting more from the health care services.