Process value of care safety: Women's willingness to pay for perinatal services

Objective: To evaluate the process value of care safety from the patient's view in perinatal services. Design: Cross-sectional survey. Settings: Fifty two sites of mandated public neonatal health checkup in 6 urban cities in West Japan. Participants: Mothers who attended neonatal health checkups for their babies in 2011 (n = 1316, response rate = 27.4%). Main Outcome Measure: Willingness to pay (WTP) for physician-attended care compared with midwife care as the process-related value of care safety. WTP was estimated using conjoint analysis based on the participants' choice over possible alternatives that were randomly assigned from among eight scenarios considering attributes such as professional attendance, amenities, painless delivery, caesarean section rate, travel time and price. Results: The WTP for physician-attended care over midwife care was estimated 1283 USD. Women who had experienced complications in prior deliveries had a 1.5 times larger WTP. Conclusions: We empirically evaluated the process value for safety practice in perinatal care that was larger than a previously reported accounting-based value. Our results indicate that measurement of process value from the patient's view is informative for the evaluation of safety care, and that it is sensitive to individual risk perception for the care process.