Preferences for hospital in the home for COVID-19: a discrete choice experiment study

This study aimed to assess Tehran residents' preferences for COVID-19 hospital in the home, using a discrete choice experiment (DCE), to support evidence-based policy-making for future health crises.

Nine hundred twenty-nine Tehran residents aged ≥ 18 years using a multistage sampling approach were surveyed. Data was collected via a structured questionnaire. Attributes (price, physician specialty, emergency contact availability, and caregiver's qualification) and levels were identified through literature review, and consultation with the experts. Data were analyzed by latent class conditional logit model, with class membership examined via a logit model. Marginal willingness-to-pay (MWTP) were calculated, and analyses were performed in Stata version 14 with 95% confidence interval.

A total of 929 participants (mean age = 36.8, SD = 10.8; 52.7% male) were included. Two latent classes were identified. In Class 1, participants were more price-sensitive (CE = - 0.02, p < 0.001), with a strong preference for emergency contact availability (CE = 5.69, p < 0.001) and combined physician teams (CE = 3.89, p < 0.001). In Class 2, price sensitivity was weaker (CE = - 0.002, p < 0.001), with lower but significant WTP values (111.95 USD for combined physician teams; 56.59 USD for emergency contact). Logistic regression showed that older age (p < 0.01), higher education (OR = 0.32, p < 0.001), very good health status (OR = 0.46, p = 0.001), COVID-19 hospitalization history (OR = 0.47, p < 0.001), and having social security/ health/ other basic insurance (p < 0.05) reduced the likelihood of class 2 membership, whereas larger family size (OR = 1.23, p = 0.003) and low income (p < 0.01) increased it; being married had a borderline significant positive association (OR = 1.52, p = 0.05).

While both groups were price-averse, decisions were mainly driven by emergency support, clinical quality (physician specialty and caregiver's qualification). These findings underscore the need for patient-centered hospital in the home care models that integrate affordability with responsive and high-quality services.