Willingness to pay methods in health care: a sceptical view.
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Attitude to Health↗
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Stated and actual altruistic willingness to pay for insecticide-treated nets in Nigeria: validity of open-ended and binary with follow-up questions.
OBJECTIVES: To determine whether the binary with follow-up (BWFU) or open-ended (OPED) contingent valuation question format would yield better valid estimates of altruistic willingness to pay (WTP) and examine the feasibility of using intra-community altruistic contributions to procure insecticide-treated nets (ITNs) for the poor in Nigeria. METHODS: Structured questionnaires were used to elicit stated altruistic WTP from a random sub-sample of respondents that had either the OPED or BWFU used to elicit WTP in Southeast Nigeria. One month after the survey the respondents were asked to redeem their WTP pledges. Construct validity was determined using econometric analyses, while phi correlation coefficient was used to determine criterion validity. FINDINGS: More than 57% of the respondents were hypothetically willing to pay for altruism in both BWFU and OPED groups. Altruistic WTP was positively related to respondents' WTP for own nets (p<0.01) and nets for other household members (p<0.05) in both groups. A total of 27.0% and 33.1% of the respondents with positive hypothetical WTP in the BWFU and OPED actually contributed. Phi correlation coefficient was 0.23 (95%CI 0.20-0.29) in BWFU and 0.49 (95%CI 0.44-0.54) in OPED. The money realised was used to buy some ITNs, which were presented to poor people selected by community leaders. CONCLUSION: The OPED elicited better valid estimates of altruistic WTP than BWFU. The potential for more capable people to contribute for the poor in ITNs programmes actually exist and malaria control programmes should explore altruistic contributions as a means to increase net coverage.
Adult↗
Health insurance and treatment seeking behaviour: evidence from a low-income country.
This paper analyses the effect of being insured under the voluntary component of Vietnamese Health Insurance, on patterns of treatment seeking behaviour. A multinomial logit model is estimated using household survey data from three provinces in Vietnam. Decisions regarding both the type of provider sought and type of care received are analysed. Insurance status is treated as both exogenous and endogenous to account for potential selection bias. The results indicate that, overall, insured patients are more likely to use outpatient facilities, and public providers, an effect that is particularly strong at lower income levels.
Adult↗
Comorbidities and the willingness to pay for reducing the risk of a targeted disease: introducing endogenous effort for risk reduction.
Previous studies demonstrated that the willingness to pay (WTP) for reducing the risk of a targeted disease increases with the severity of a comorbidity condition. They evaluated the WTPs at positions where otherwise identical individuals who have unequal comorbidity conditions all have the same consumption of wealth and the same probability of getting a targeted disease. This paper endogenizes the individual effort to reduce the risk of the targeted disease. It finds that individuals with more severe comorbidity will spend more on reducing the risk of the targeted disease and, therefore, have a lower probability of getting the targeted disease and a lower net consumption of wealth at equilibrium. Nonetheless, we find that the previous conclusion concerning the relationship between the WTP for the targeted risk reduction and the comorbidity is robust.
Comorbidity↗
Waiting time and doctor shopping in a mixed medical economy.
Waiting time generally acts as a rationing mechanism in the public health care system. In theory, patients who have a higher valuation of time are more likely to seek alternative care (i.e. doctor shopping) if there is a parallel private sector than those who have weaker time preference. However, the existing settings of many health care systems do not allow patients to reveal their preference of such. The data presented in this study suggest a positive association between patients' expressed value of time and doctor shopping behaviour in Hong Kong. Patients who were assigned longer waiting times relative to their expected horizon were more likely to seek private alternative care.
Adolescent↗
Willingness to pay for low-lung-cancer-risk cigarettes in Taiwan.
This study develops a conceptual framework based on the random utility model to estimate smokers' willingness to pay (WTP) for the hypothetical low-lung-cancer-risk cigarettes in Taiwan. Following the approach taken by Viscusi (J Polit Econ 1990; 98: 1253-1269), an individual's subjective risk perception on the probability of developing lung cancer from smoking cigarettes was measured and used in the estimation of demand for safer cigarettes. Other factors that may affect a smoker's purchase decision toward the hypothetically safer cigarettes are also identified. The average WTP for one pack of low-lung-cancer-risk cigarettes is estimated to be 44.15 NT dollars, which represents a 152% price increase over the average price of cigarettes currently sold in the market.
Adult↗
Valuation of the risk of SARS in Taiwan.
Two surveys conducted in Taiwan during the spring 2003 severe acute respiratory syndrome (SARS) epidemic reveal a high degree of concern about the threat posed by SARS to Taiwan and its residents, although respondents believe they are knowledgeable about the risk of SARS and that it is susceptible to individual control. Willingness to pay (WTP) to reduce the risk of infection and death from SARS is elicited using contingent valuation methods. Estimated WTP is high, implying values per statistical life of US dollars 3 to 12 million. While consistent with estimates for high-income countries, these values are substantially larger than previous estimates for Taiwan and may be attributable to the high degree of concern about SARS at the time the data were collected.
Adult↗
Public and private pharmaceutical spending as determinants of health outcomes in Canada.
Canadian per capita drug expenditures increased markedly in recent years and have become center stage in the debate on health care cost containment. To inform public policy, these costs must be compared with the benefits provided by these drugs. This paper measures the statistical relationship between drug spending in Canadian provinces and overall health outcomes. The analysis relies on more homogenous data and includes a more complete set of controls for confounding factors than previous studies. Results show a strong statistical relationship between drug spending and health outcomes, especially for infant mortality and life expectancy at 65. This relationship is almost always stronger for private drug spending than for public drug spending. The analysis further indicates that substantially better health outcomes are observed in provinces where higher drug spending occurs. Simulations show that if all provinces increased per capita drug spending to the levels observed in the two provinces with the highest spending level, an average of 584 fewer infant deaths per year and over 6 months of increased life expectancy at birth would result.
Aged↗
Influences of the absence of random assignment of bids on estimating willingness to pay using a discrete-choice question.
This study examined the influences of the interaction between a bid and the respondent's characteristics due to insufficient random assignment of bids on the estimation of willingness to pay (WTP) using data from a discrete-choice question. A contingent valuation survey of 152 examinees undergoing X-ray testing for gastric cancer screening was conducted, and the median and mean WTP for the serum pepsinogen test were estimated using a logistic regression model to which the interaction terms between the bid and the respondent's characteristics, which included gender, age, annual income, frequency of prior use of a gastric cancer screening program, and perceived health, were added. There were remarkable differences in the estimated WTP according to whether the interaction term of annual income, to which the bids had failed to be assigned randomly and which had been positively correlated with the bid, was added in the model. It is suggested that it may be necessary to check if the bids were randomly assigned to the respondent's characteristics and, when correlations with the bid are found, to adjust their interaction effects.
Age Factors↗
Inter-rater and test-retest reliability of three contingent valuation question formats in south-east Nigeria.
This paper examines the inter-rater and test-retest reliability of willingness to pay (WTP) for insecticide-treated mosquito nets and net re-treatment using the bidding game (BG), binary with follow-up (BWFU) and a novel structured haggling technique (SH). Inter-rater reliability was evaluated by having two sets of interviewers administer questionnaires to 109 (BG), 110 (BWFU) and 103 (SH) randomly selected household heads. Test-retest reliability was investigated by repeating interviews on 146 (BG), 161 (BWFU) and 139 (SH) household heads one month after an initial survey. Data analysis used testing of means, Spearman's correlation and Pearson's correlation coefficient for test of reliability, while non-parametric analysis was used to determine factors causing a variation in WTP. The study was conducted in Southeast Nigeria. Inter-rater reliability coefficients were estimated for the individual's WTP for own nets, WTP for others and WTP for re-treatment. Using WTP for own nets as the best reliability estimate, the coefficients were high at values of 0.77 (C.I. 0.72-0.86), 0.75 (C.I. 0.64-0.81) and 0.74 (C.I. 0.63-0.82) in the BG, BWFU and SH, respectively. In test-retest reliability coefficients, the coefficients for WTP for own nets were low-to-moderate at values of 0.51 (C.I. 0.40-0.62), 0.41 (C.I. 0.28-0.53) and 0.56 (C.I. 0.41-0.65) for the BG, BWFU and SH groups, respectively. Factors such as gender, change in income, unplanned expenditures, stated WTP in first survey, time-to-think, external information, and subjecting respondents to more than one interview explained the lower test-retest reliability coefficients. We conclude that the CVM was reliable in the study area and the question formats had similar levels of reliability. The lower coefficients in the test-retest reliability were due to the influence of factors affecting demand that had changed in the intervening period. Standard formats for determining reliability within CVM should be developed for easy comparison of results from different studies.
Animals↗
Warm glow, free-riding and vehicle neutrality in a health-related contingent valuation study.
Criticism of contingent valuation (CV) stresses warm glow and free-riding as possible causes for biased willingness to pay figures. We present an empirical framework to study the existence of warm glow and free-riding in hypothetical WTP answers based on a CV survey for the measurement of health-related Red Cross services. Both in conventional double-bounded and spike models we do not find indication of warm glow phenomena and free-riding behaviour. The results are very robust and insensitive to the applied payment vehicles. Theoretical objections against CV do not find sufficient empirical support.
Austria↗
Technology and managed care: patient benefits of telemedicine in a rural health care network.
Rural health providers have looked to telemedicine as a technology to reduce costs. However, virtual access to physicians and specialists may alter patients' demand for face-to-face physician access. We develop a model of service demand under managed care, and apply the model to a telemedicine application in rural Alaska. Provider-imposed delays and patient costs were highly significant predictors of patient contingent choices in a survey of ENT clinic patients. The results suggest that telemedicine increased estimated patient benefits by about $40 per visit, and reduced patients' loss from rationing of access to physicians by about 20%.
Adolescent↗
The welfare loss from hospital cost-shifting behavior: a partial equilibrium analysis.
Cost shifting occurs when changes in administered prices of one payer lead to compensating changes in prices charged to other payers. Microeconomic theory suggests that cost shifting can take place under limited conditions and some empirical studies indicate that that hospital cost shifting may have actually occurred at various times. This study designs a model to conceptualize and quantify the potential welfare loss caused by hospital cost shifting under idealized yet fairly plausible conditions. The resulting estimate yields only a small efficiency loss of at most, 0.84% of private hospital expenditures in the US for 1992.
Cost Allocation↗
Inequality decomposition and geographic targeting with applications to China and Vietnam.
How far are income-related inequalities in the health sector due to gaps between poor and less poor areas, rather than due to differences between poor and less poor people within areas? This note sets out a method for answering this question, and illustrates it with two empirical examples. The disproportionate accrual of health subsidies to Vietnam's better-off is found to be largely due to the fact that richer provinces have larger per capita subsidies, while pro-rich inequalities in health insurance coverage in rural China are found to be largely due to the fact that better-off villages have been more successful at preventing the collapse of their insurance schemes.
Catchment Area, Health↗
The economic value of informal care: a study of informal caregivers' and patients' willingness to pay and willingness to accept for informal care.
We provide a new test of the feasibility of using contingent valuation to value informal care. We start with a theoretical model of informal caregiving and derive that willingness to pay depends positively on wealth and negatively on own health, whereas the effect of other's health is sign-ambiguous. These predictions are tested in two new data sets on patients' and caregivers' willingness to pay (WTP) and willingness to accept (WTA) for informal care. The data are generally consistent with the theoretical predictions: wealth generally has a positive impact and own health a negative impact. Other's health has a mixed effect. We find only small differences between WTP and WTA. Our findings suggest that contingent valuation may be a useful technique to value informal care in economic evaluations of health care.
Aged↗
Consumer payment patterns for primary health care services in low-income communities of Rio de Janeiro: implications for designing service financing schemes.
Primary health care (PHC) services are now recognized as a mainstay of development in low-income regions of the world. Yet, in many of these areas, economic conditions that include a burgeoning international debt, precipitous drops in the prices of raw materials, expanding population bases, and faltering currency rates, make the effective financing of PHC services an issue requiring the most immediate attention. A potentially valuable source of assistance in such endeavors is data on consumers' payment patterns for PHC services, and on socioeconomic conditions within their communities. The Centro de Pesquisas de Assistência Integrada à Mulher e à Criança (CPAIMC), the principal private source of PHC in Rio de Janeiro, has collected these type of data for nine low-income communities (LICs) within the Greater Rio de Janeiro Metropolitan Region. The current paper interfaces these data with previously developed solutions to address the problem of financing PHC services within the nine LICs. The solutions were recommended by a methodology developed and implemented by two of the authors. Results indicate that the consumer payment pattern and socioeconomic data support the methodology's recommendations and, more importantly, may be used to improve the effectiveness of those recommendations. Examples are provided and implications discussed.
Brazil↗
Community financing of drugs in Sub-Saharan Africa.
'Health for all by the year 2000' is unlikely to be achieved in a number of Third World countries, including those in Sub-Saharan Africa, if reliance is placed solely on the public health budget. This article looks at a range of alternative and additional sources of revenue and, in particular, at the scope for community financing of drugs. Developments in the region are reviewed for their insights into the strengths and weaknesses of each financing scheme; and, as a guide to shaping policies that make an appropriate choice of method of health care financing.
Africa↗
Health services financing in Poland.
The right to a free health service is identified as one of the founding rules of socialism; yet other sources of funding, both public and private, should not be neglected. This article reviews the major sources of financing health services in Poland. In particular, a description is made of the size and composition of funding from non-governmental sources including: quasi-budget funds, other funds, and out-of-pocket payments; and some proposals are made for change. Further work is needed in developing the criteria by which policy choices can be made, and in developing the information base; at the same time, political and social criteria will still be very important, not least on the issue of user charges.
Financing, Government↗