A Consumer Preference Approach to the Planning of Rural Primary Health-Care Facilities

A problem in planning the expansion of a rural primary health-care delivery system is to determine the set of facilities to be added to an existing system so as to maximize the incremental benefit to the community subject to a cost constraint. The proposed approach involves the following five steps: (1) identification of facility attributes relevant to patients in their choice of health-care facilities, (2) modeling of an individual's overall preference for alternate facilities as a weighted linear function of these facility attributes, (3) transformation of each consumer's preference model into a benefit function expressing the individual's benefit in dollars/year for an existing or potential facility, (4) provision of a method for determining the total incremental benefit to the community from a set of proposed health-care facilities, and (5) use of a heuristic procedure to determine a set of facilities that yields near-optimum total incremental benefit subject to the cost constraint. A practical application of the proposed approach reveals that the consumer preference model has substantial reliability and predictive validity.