Patient preferences in the context of scope of practice expansion: Evidence from gynecological care in France

Pauline Kergall (), Quitterie Roquebert () and Jonathan Sicsic ()
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Pauline Kergall: BETA - Bureau d'Économie Théorique et Appliquée - AgroParisTech - UNISTRA - Université de Strasbourg - Université de Haute-Alsace (UHA) - Université de Haute-Alsace (UHA) Mulhouse - Colmar - UL - Université de Lorraine - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, UNISTRA - Université de Strasbourg
Quitterie Roquebert: BETA - Bureau d'Économie Théorique et Appliquée - AgroParisTech - UNISTRA - Université de Strasbourg - Université de Haute-Alsace (UHA) - Université de Haute-Alsace (UHA) Mulhouse - Colmar - UL - Université de Lorraine - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, UNISTRA - Université de Strasbourg
Jonathan Sicsic: LIRAES (URP_ 4470) - Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé - UPCité - Université Paris Cité, LIEPP - Laboratoire interdisciplinaire d'évaluation des politiques publiques (Sciences Po) - Sciences Po - Sciences Po

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Abstract: In order to cope with the shortage of medical workforce, many healthcare systems are extending the scope of practice of healthcare professionals. This paper investigates patients' preferences when faced with multiple providers for a given medical service. We focus on gynecological care for non-pregnant women in the French healthcare market, where this care can be provided by either gynecologists, general practitioners, or midwives. We conducted a discrete choice experiment with a representative sample of 1,745 French women to study their choice of provider, which differed systematically in terms of waiting time, gender, patient-centered behavior, source of provider recommendations, and out-of-pocket costs. We assessed preference heterogeneity and its associations with factors such as age, geographic location, previous healthcare experiences and risk aversion. Although we find evidence that women are sensitive to provider type, they primarily prioritize female providers, shorter waiting times, and lower costs. Preferences vary significantly across subgroups: younger women, those who have recently been pregnant, and those who have had negative experiences with gynecologists are more inclined to choose midwives. Additionally, higher risk aversion correlates with a stronger preference for gynecologists. Simulations of market shares based on observed characteristics confirm that costs and gender dominate over professional groups. We provide additional results regarding opt-out decisions and the influence of consultation reasons. Overall, our study informs policymakers on the key roles of cost and gender in women's care decisions. Their dominance is stable across preference heterogeneity but could be counterbalanced by other attributes such as waiting time and patient-centered behavior.

Keywords: Discret choice experiment; Preferences; Sexual health; Gynecological care (search for similar items in EconPapers)
Date: 2026-10-26
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Published in European Journal of Health Economics, 2026, ⟨10.1007/s10198-026-01999-0⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:spmain:hal-05849147

DOI: 10.1007/s10198-026-01999-0

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