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PubMed2005

Continence pads: have we got it right?

Women listed in the Croydon Community Continence database were contacted with a self-assessment questionnaire regarding continence pad usage and quality of life. Completed questionnaires were received from 763 of 1509 (51%) participants. Pads were used for bladder dysfunction (88.1%) and bowel dysfunction (44%). The majority (82.5%) had concurrent medical disorders and problems with mobility with 77.5% being on one or more types of medication. Nearly 39% of women claimed that they would be happy to continue pad use indefinitely and only 28% expressed interest in seeking further help. Compared to bowel dysfunction, bladder dysfunction appeared to have a greater impact on women's quality of life (P < 0.001). Containment products make a substantial contribution in improving the quality of lives of women with bowel and bladder dysfunction. The financial burden of containment products has a major impact on the health budget and therefore, comprehensive clinical evaluation should be mandatory before relegating women to pads as a final resort.

Activities of Daily Living↗
PubMed2003

Changing role of non-timber forest products (NTFP) in rural household economy: the case of Sinharaja World Heritage site in Sri Lanka.

This paper examines the modified patterns of utilizing non-timber forest products (NTFP) and associated behavioral changes around tropical forest areas in the context of conservation-related objectives and other commercially driven objectives. Our study introduces a conceptual framework based on the household production theory and tests empirically the hypotheses drawn at Sinharaja World Heritage in Sri Lanka. The results show that conditions introduced by forest conservation programs and the spread of small-scale commercial tea cultivation are transforming the economy around Sinharaja. The process is an economically rational one where resident communities decide upon their actions based on the opportunity cost of time involved with NTFP in the absence of observable prices. Although the process, overall, has led to a decline in the role of NTFP in the household economy, its impact over different NTFP are not uniform, leaving sustained demand for certain NTFP. This situation calls for a multifaceted approach in forest management programs to address the various household needs fulfilled by NTFP-based activities.

Commerce↗
PubMed2004

Multiple benefits of carbon-friendly agricultural practices: empirical assessment of conservation tillage.

This study empirically estimates the multiple benefits of a subsidy policy that would offer payments to farmers in return for the adoption of conservation tillage, and compares the outcomes of alternative targeting designs for such a policy. The least-cost incentive payment policy schemes are simulated for the State of Iowa by using the data for roughly 12,000 National Resource Inventory (NRI) points. We use an economic conservation tillage adoption model to evaluate the costs of adoption and a physical process simulation model (EPIC) to estimate the environmental benefits due to adoption at each of the NRI points. Two targeting options are considered. We assess the costs and environmental consequences of a practice-based policy instrument (which maximizes the acres of land in conservation tillage, regardless of its level of environmental benefits) and contrast it to a performance-based instrument (which yields the highest amount of environmental benefits per dollar spent). Carbon sequestration in agricultural soils, reduction of soil erosion by wind and water, and the reduction in nitrogen runoff are considered as possible targets for the performance-based instruments. We find that the practice-based instrument provides high proportions of the four benefits relative to the policies that target the benefits directly, especially at the higher policy budget levels. Similarly, we estimate that targeting one of the four benefits individually provides high percentages of the other benefits as compared with the amounts of the benefits obtainable if they were targeted directly.

Agriculture↗
PubMed2005

[18 months law for the modernisation of the SHI--review and prospects].

Balance of the law for the modernisation of the statutory health insurance (SHI) (GKV-Modernisierungsgesetz-GMG) is contradictory as measured by the original objectives. Although the legislators curtailed benefits and raised the co-payments, those insured could not profit from lower contributions. The anticipated lowering of the ancillary wage costs was missing thereby. However, many SHI funds could settle debts, but the expenditures rose again in 2005. The financial situation of most SHI funds is still strained. The new federal government will have to tackle a further and sustainable reform of the statutory health insurance soon.

Financing, Personal↗
PubMed1998

Oncology Home Care Service.

The Oncology Home Care Service in Basel provides nursing support to let cancer sufferers choose where they receive palliative care. Most of the cost is borne by the patient's health insurance.

Adolescent↗
PubMed2005

Order bias in estimates of willingness to pay for drugs to treat attention-deficit/hyperactivity disorder.

This study investigated the presence of order bias in contingent valuation studies. We compared the willingness to pay (WTP) for an improved drug for attention-deficit/hyperactivity disorder with that for the standard drug and examined whether the order in which the drugs are presented influences the results obtained. A pretested questionnaire was administered to 114 university students. WTP was elicited using the payment card method. A split sample was used to test order bias. The average WTP per month was euro 57.34 for the standard drug and euro 81.95 for the new drug. The results show that WTP for a new drug varies according to the order in which the drugs are presented. Respondents stated a higher WTP for the new drug if the standard therapy was presented first. This may be due to order bias, evidence of which has also been found in other studies and which is considered to be a limitation of the method. Finally, the use of marginal WTP is suggested as a solution.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

German health care system in transition. The difficult way to balance cost containment and solidarity.

As is the case with all other health care systems, the German one is in constant transition. The reasons--such as costly medical innovations, aging population, and lack of overall economic growth--are well known, widely discussed, and not unique to Germany. Although the problems are not unique to Germany, there are some trends in each country which may be of interest to other countries. This contribution provides an update on the German health care system and reports current reform trends.

Advisory Committees↗
PubMed2006

Patients' willingness to pay for electronic communication with their general practitioner.

Despite the common use of electronic communication in other aspects of everyday life, its use between patients and health care providers has been slow to diffuse. Possible explanations are security issues and lack of payment mechanisms. This study investigated how patients value secure electronic access to their general practitioner (GP). One hundred and ninety-nine patients were asked an open-ended willingness-to-pay (WTP) question as part of a randomised controlled trial. We compared the WTP values between two groups of respondents; one group had had the opportunity to communicate electronically with their GP for a year and the other group had not. Fifty-two percent of the total sample was willing to pay for electronic GP contact. The group of patients with access revealed a significantly lower WTP than the group without such access. Possible explanations are that the system had fewer benefits than expected, a presence of hypothetical bias or simply a preference for face-to-face encounters.

Adult↗
PubMed2006

Test-retest reliability of willingness to pay.

We describe the results of a survey designed to assess the test-retest reliability of a method of establishing willingness to pay. Willingness to pay values for a hypothetical intervention were elicited from a randomly selected, population sample by face-to-face interview on three occasions over a period of 5 weeks. Test-retest reliability was assessed by intraclass correlation and by generalizability analysis. Reliability was acceptable but not substantial, and there was a statistically significant shift in mean value between first and second assessments. The greatest source of variation in values was the participants. There was also a substantial interaction between time and participants, suggesting that some respondents changed their answers at follow-up. The results were sensitive to the high valuations provided by four of the participants, however.

Australia↗
PubMed2003

The importance of skin disease as assessed by "willingness-to-pay".

BACKGROUND: To achieve optimal resource allocation in health care, it is necessary to value competing resource uses according to the benefit derived from those uses. Skin disease makes as great an impact as other serious medical conditions when assessed by effects on health-related quality of life. OBJECTIVE: To confirm the high impact of skin disease by comparing patients' willingness to pay (WTP) to be cured or relieved from symptoms of skin and nonskin conditions. METHODS: We searched the published literature on WTP to compare the impact of dermatologic conditions with the impact of other medical conditions. A total of 46 articles were identified of which 10 included information on willingness to pay for cure reported on a monthly basis. RESULTS: WTP for skin diseases fell in the range of 125-260 dollars/month and was comparable or higher than all but one of the other identified conditions. CONCLUSION: Willingness to pay for relief from skin diseases is comparable to that for relief of other serious medical conditions. Skin diseases are associated with a significant adverse impact on patients' lives.

Cost-Benefit Analysis↗
PubMed2006

Air quality improvement estimation and assessment using contingent valuation method, a case study in Beijing.

The aim of the paper is to estimate and assess residents' willingness to pay to improve air quality in the urban area of Beijing using the Contingent Valuation Method (CVM). The mean willingness to pay (WTP) for a 50% reduction of harmful substances in the air was 143 CNY per household per year, and the total WTP of the residents in the study area was 336 million CNY per year. As a proportion of household annual income, the mean WTP amounted to 0.7%. Four socio-economic variables were found to have significant impacts on residents' willingness to pay. The analysis results illustrated that WTP increases with income and education level, and decreases with household population and age. The willingness was larger for residents in the urban districts than those in the suburban districts. It was found that most of the protest bids lay on interviewees' incomplete perception of the values of environmental amenity. The influence of household income on people's willingness to pay illustrated in this study reflects a causal force of Beijing's transition to market economy that households created to have disposable income are more likely to care about environmental quality. The results of this study strike an optimistic note on the possibility of measuring the total economic value of environmental quality improvement by using the CVM in China. Suggestions on implication of the CVM for both academics and policy makers are provided in the paper.

Air↗
PubMed2005

Innovations in health care financing: new evidence on the prospect of community health insurance schemes in the rural areas of Ethiopia.

It has become clear that due to market failure, state failure, and other reasons, the conventional sources of finance alone could not solve the health problem of the rural population, particularly that of the socially excluded and disadvantaged groups. Community Based Health Insurance Schemes (CBHIS) are one of the most recently mentioned options to narrow the existing inequalities in access to basic health services. This study assesses the prospect of CBHIS in the rural areas of Ethiopia using a double bounded dichotomous contingent valuation method. The results show that even in one of the poorest countries of the world, there is a promising prospect to introduce CBHIS.

Attitude to Health↗
PubMed2005

Willingness-to-pay and demand curves: a comparison of results obtained using different elicitation formats.

Health economists use "willingness-to-pay" to assess the prospective value of novel interventions. The technique remains controversial, not least with respect to the formats under which values are elicited. The paper analyses the results of a series of studies of the same intervention valued by the same population, in which different elicitation formats were employed. The findings support the hypothesis that data collected using different formats give rise to different demand curves, from which different inferences about demand elasticity, profitability and consumer surplus will be derived. Judgements as to the relative merits of rival interventions depend crucially upon whichever format has been used to evaluate each intervention.

Fees and Charges↗
PubMed2005

Demography of aging in China and the United States and the economic well-being of their older populations.

Today China has the world's largest older population, defined as aged 65 and over. The size of the older population in the United States is also large, ranking third in the world in 2000. The combined older populations of China and the United States represented 29 percent of the world's population 65 and older in 2000. The large older populations in these two countries are projected to more than double in size over the next three decades. Although currently China is younger than the United States and many other countries, its aging process will accelerate in the next few decades, with a speed surpassing the experience of many Western European countries and the United States. This paper examines the current and future situation of the older population in China and compares China's aging with that of the United States, using 2000 and earlier censuses from both countries as well as the population projections data from the U.S. Census Bureau. Growth of the older population, changes in the age distribution in China with comparisons to the United States, and the projections of the older population's future growth are analyzed and presented. The paper also discusses sources of financial support and living arrangements in China and the United States. Finally, the paper assesses trends in the older population support ratio and the implications for the economic well-being of an aging population.

Age Distribution↗
PubMed2006

Avoiding free care at all costs: a survey of uninsured patients choosing not to seek emergency services at an urban county hospital.

The purpose of this case study was to understand why many uninsured patients opt not to make use of a free public hospital when it is available, instead seeking emergency department care at sites where they will be billed for the services they receive. One hundred fifty seven uninsured patients were interviewed over an 8-week period at three emergency departments that bill for services near a county hospital that provides free care. Data was gathered on income, health status, and credit history. Subjects were also asked if they had previously sought care at the county hospital and, if they had, how satisfied they were with the quality of care and with the wait time. Seventy two percent of the subjects reported household incomes of <$20,000, 48% reported they were in fair or poor health, and 33% said they were unable to pay at least one medical bill at the site where they were seeking care. 65% reported they had previously received care at the county hospital, and of these 61% said they were not-too-likely or not-at-all likely to return. In a regression analysis, experience with wait time correlated with subjects willingness to return, whereas their satisfaction with quality, their income, problems with debt, and reported health status did not. Access involves more than geographic proximity and affordability. Excessive wait times can deter even patients who are poor, in ill health and in debt from making use of services that are intended for their benefit.

California↗
PubMed2003

Masked ball: ethics, laws and financial contradictions in Hungarian health care.

Corruption is a major problem in the societies of the post-communist Central European countries. Corruption in health care has some unique characteristics undermining the efficacy of and respect for Hungarian health care. One of the forms of corruption is tipping. This highly contested phenomenon is present in most of the patient/health professional's interactions in a sophisticated manner, raising serious ethical and legal dilemmas. The present paper analyzes tipping and other corruption-related factors, such as financial conflict of interest between industry and health care and argues that since ethical and legal considerations are often ignored in the country, patient care and clinical research are affected by these controversial issues to a great extent.

Abortion, Legal↗