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

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 influencedWTP, but patients with higher estimates of total visit cost were more likely to have higher WTP (beta coefficient, 0.27; SE, 0.05; adjusted R-2 = 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.