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PubMedDate not supplied

Characteristics of people living with HIV who use community-based services in Ontario, Canada: implications for service providers.

Community-based AIDS service organizations (CBAOs) direct services to multiple-needs people living with HIV/AIDS who are less likely to use mainstream health promotion services. As people live longer with HIV, the potential to enhance quality of life increases, yet little is known about who uses CBAOs or how this use affects other health and social services. This study of people living with AIDS in Ontario, Canada (n = 297) examined the demographic and health-related characteristics of people with AIDS who do and do not use CBAOs and their patterns of mainstream service utilization. It found that users of CBAOs were significantly less healthy, less able to sustain normal activities, and more often depressed. They reported physical disabilities significantly more often. Their quality of life was also lower along certain dimensions. They were significantly poorer and more reliant on government income supports. They consumed significantly more nonhospital health and social services and had significantly higher out-of-pocket costs. These results suggest CBAOs are being accessed appropriately by those most vulnerable. In an effort to strengthen CBAO capacity to recognize and address depression and physical health problems prevalent among their clients, links to other mainstream health promotion and social services is recommended.

Adaptation, Psychological↗
PubMed2005

Quality-adjusted life years was a poor predictor of women's willingness to pay in acute and chronic conditions: results of a survey.

OBJECTIVE: We investigated the relationship between quality-adjusted life years (QALYs) and willingness to pay (WTP) in acute and chronic conditions. STUDY DESIGN AND SETTING: Face-to-face interviews were used to collect data in a convenience sample of women. Participants completed one interview evaluating preferences for an acute condition, post-chemotherapy nausea and vomiting (PCNV), and the other interview for a chronic condition (breast cancer). Preferences were elicited for QALYs using visual analogue scale (VAS), and standard gamble in addition to WTP. Because QALYs and WTP are purportedly based on the same underlying theoretical foundations, WTP was regressed onto change in QALYs, age, income, and health status. RESULTS: Regression analysis reported statistically significant models for all breast cancer (P < .001) and PCNV (P < .05) conditions tested. However, QALY was not a significant predictor of WTP. CONCLUSION: The results of this study indicate QALYs was a poor predictor of WTP for the conditions tested. Linear combinations of change in QALYs, age, income, and health status were a better predictor of WTP for chronic than acute conditions. This can be attributed to violations of underlying assumptions in measurement of QALYs with acute conditions and to problems with the use of WTP with chronic conditions.

Acute Disease↗
PubMed2004

On the possibility of a bridge between CBA and CEA: comments on a paper by Dolan and Edlin.

In a recent work by Dolan and Edlin, it is concluded that no link can be established between cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). However, the conclusion seems to depend rather heavily on what is understood by a link between CBA and CEA as well as on the exact meaning of the latter two terms. We argue that there is at least one approach to CBA and CEA in which the two are very intimately linked. On the other hand, the limitations in the access to preference information has consequences for the kind of questions that can be meaningfully addressed in both CBA and CEA.

Attitude to Health↗
PubMed2004

Private medical insurance and saving: evidence from the British Household Panel Survey.

This paper uses the British Household Panel Survey for the years 1996-2000 to investigate the relationship between saving and private medical insurance in the UK. Because the National Health Service (NHS) gives comprehensive health coverage and is generally free at source, one would not expect private medical insurance to crowd-out saving. However, the NHS being characterised by long waiting lists and generally poor quality, many people prefer to use private health services. In such circumstances, those individuals who are not covered by private medical insurance, and who are therefore more exposed to facing unexpected out-of-pocket private health care expenditures or income losses while waiting for public treatment might save more for precautionary reasons than those who are covered. According to our findings, which are based on a wide range of econometric specifications, there is a positive association between insurance coverage and saving, suggesting that private medical insurance does not generally crowd-out private saving. However, we found some evidence of crowding-out in those areas where the quality of medical facilities is perceived as poor, and in rural areas, characterised by fewer NHS providers.

Cost Savings↗
PubMed2004

Anti-social welfare functions: a reply to Hansen et al.

We could reasonably expect society to give at least the same weight to the marginal utility of the poor as to the rich, and to the marginal utility of the ill as compared to the healthy. Whilst Hansen et al. [Journal of Health Economics (2004)], may be said to link CEA and CBA within a welfarist framework, the assumptions they require are inconsistent with these types of ethical preferences. Thus, the degree to which they employ a reasonable social welfare function is doubtful. This paper argues that any link between CEA and CBA will occur not within a welfarist framework but instead within a non-welfarist one in which it is unlikely that CBA results could be easily transformed into cost-effectiveness ratios.

Attitude to Health↗
PubMed2004

A stated preference approach to assessing health care-quality improvements in Palestine: from theoretical validity to policy implications.

User fees have been promoted as a potential complementary funding mechanism for health care in developing countries. In this paper, we appraise the use of contingent valuation (CV) as a tool to help develop user fees schemes that could be used to assist in allocating, and partially fund, health care. A random sample of 499 patients seeking care in primary health care centers, in Palestine, were asked to reveal their willingness to pay values for specified improvements in the quality of delivered medical care. Empirical analysis suggests that, in this context, CV can lead to internally consistent results and useful policy implications.

Adult↗
PubMed2005

The effect of premiums on the decision to participate in health insurance and other fringe benefits offered by the employer: evidence from a real-world experiment.

In this paper, we investigate the effect of the out-of-pocket premium on the decision to enroll in employer health insurance and other benefits plans including dental insurance, vision care, long-term care insurance, and wellness benefits. Previous estimates of the effects of premium on takeup of health insurance could be biased toward zero due to a correlation between premium and unobservable demand or plan quality. We solve this problem using data representing hypothetical choices by employees under three different price regimes, providing price variation uncorrelated with either individual-specific or plan-specific unobservables. We find that workers are insensitive to price in health insurance takeup. Workers show much greater price sensitivity to decisions about dental insurance, vision plans, long-term care insurance, and wellness benefits. We conclude that premium subsidies are unlikely to have a substantial impact on increasing insurance rates of workers already offered employer insurance.

Decision Making↗
PubMed2005

Sensitivity to scale in contingent valuation: the importance of the budget constraint.

The possible insensitivity of willingness-to-pay (WTP) values to changes in scale continues to cause concern within the contingent valuation (CV) literature. Although several reasons for this phenomenon have been suggested, empirical evidence both supports and refutes insensitivity. This paper presents data that suggest that insensitivity may be significantly determined by the individual's budget constraint: the higher the proportion of income the expressed WTP represents, the greater the insensitivity of that WTP to changes in the scale of the good, irrespective of changes in underlying marginal utility. The methodological implication for CV studies in health care is outlined.

Budgets↗
PubMed2004

Benefits transfer of willingness to pay estimates and functions for health-risk reductions: a cross-country study.

This paper provides a first application of the techniques of benefits transfer to the health economics literature. These techniques seek to transfer the value of some good from one 'survey' context to a new 'policy' context so avoiding the need for new valuation surveys each time a new policy question arises. Two approaches to benefits transfer are assessed: the simple transfer of mean values and the transferral of value functions. We develop a new methodology for the latter approach in which value functions are iteratively built up from theoretical principles with transfer errors being tested each time a new variable is added. Through a novel application of advanced statistical tests we show that this approach outperforms the transferral of statistically driven Best-fit functions. The case study presented focuses upon the transfer of contingent valuation (CV) willingness to pay (WTP) estimates and associated value functions for reducing the health risks associated with solar ultraviolet (UV) exposure. Common format studies are conducted in four countries with transfers between all of these being undertaken. By calculating errors in predicted versus actual values across countries we show that, when transferring between similar contexts, simple mean-value transfers outperform more complex value function transfers (with the magnitude of the former errors being encouragingly small). However, this result is reversed when transfers are undertaken across dissimilar contexts where value functions partially adjust for these differences. In summary these findings provide support and guidance for future applications.

Financing, Personal↗
PubMed2005

Implicit versus explicit ranking: on inferring ordinal preferences for health care programmes based on differences in willingness-to-pay.

The paper explores the merit of the willingness-to-pay (WTP) method as a way to elicit public preferences regarding health care priorities. The aim is to test the extent to which the implicit ranking inferred from the ordinal differences in WTP-values corresponds with respondents' explicit ranking of the same programmes. This issue of convergent validity is explored by face-to-face interviewing of population samples in six European countries-in total 1240 respondents. The most consistent result is the inconsistency of WTP and explicit ranking in all six countries. The convergent validity of WTP is low, particularly among those who did not state different WTP-values on the three programmes being considered.

Europe↗
PubMed2005

The welfare cost of violence across countries.

The cost of violence goes beyond its material dimension, including also the welfare loss due to higher mortality. A given mortality, and its distribution across age groups, determines a reduction in life expectancy that can be valued using the marginal willingness to pay approach. We estimate the health dimension of the welfare cost of violence for 73 countries. On average, 1 year of life expectancy lost to violence is associated with a yearly social cost of 3.8% of GDP. The health dimension increases the estimated social costs of violence by 40% in the United States and by 57% in Latin America.

Adolescent↗
PubMed2006

Do health sector reforms have their intended impacts? The World Bank's Health VIII project in Gansu province, China.

This paper combines differences-in-differences with propensity score matching to estimate the impacts of a health reform project in China that combined supply-side interventions aimed at improving the effectiveness and quality of care with demand-side measures aimed at expanding health insurance and providing financial support to the very poor. Data from household, village and facility surveys suggest the project reduced out-of-pocket spending, and the incidence of catastrophic spending and impoverishment through health expenses. Little impact is detected on the use of services, and while the evidence points to the project reducing sickness days, the evidence on health outcomes is mixed.

China↗
PubMed2006

Exploring preference anomalies in double bounded contingent valuation.

Double bounded dichotomous choice (DBDC) contingent valuation offers increased efficiency of willingness to pay (WTP) estimates compared with the single bounded format. However, evidence suggests DBDC generates anomalous respondent behaviour. This paper provides the first investigation and explanation of these anomalies in health. Results suggest the incentives for truthful preference revelation are altered in the presence of a follow up question. This result is found using both regression techniques and analysis of raw responses. Although findings suggest 'very certain' respondents exhibit less anomalous behaviour inconsistencies remain across bounds. The results of this study question the use of iterative valuation formats.

Air Ambulances↗
PubMedDate not supplied

Atopic dermatitis in Italian children: evaluation of its economic impact.

INTRODUCTION: The aim of our study was to evaluate the economic impact of atopic dermatitis (AD) on the family of young children affected by the disease in Italy. METHODS: Thirty-three families of young children affected by AD were asked to fill in a questionnaire about financial costs associated with providing health care during the past year for their child affected by AD. For each child AD severity was evaluated by using the SCORAD index. RESULTS: By analyzing the questionnaire, an annual average cost of 1254euro (about U.S. $1540) for each family was determined. Main expenses concern the use of moisturizing therapies, particular detergent, and private specialist consultations. Annual family average cost was lower for children with mild AD compared with those with moderate to severe AD. DISCUSSION: AD has a deep impact on the family budget, with an increasing cost in proportion to the increasing severity of the disease. These data support previous reports suggesting that the management of AD in children is complex and costly, altering the quality of life of children and their families.

Attitude to Health↗
PubMed2005

Who pays more for health services in middle-income countries: lessons from Mexico.

An evaluative study with a cross-sectional design was carried out on healthcare cost indicators reported by the 2000 National Health Survey in Mexico, to determine which population group had higher health costs/expenditures in relation to family income. The results suggest that in middle-income countries such as Mexico, families with lower incomes tend to pay more for healthcare services.

Cross-Sectional Studies↗
PubMed2005

Patients' willingness to pay for pharmacist-provided menopause and hormone replacement therapy consultations.

OBJECTIVE: To determine what women would be willing to pay for pharmacist-provided menopause and hormone replacement therapy consultations and the relationship between willingness to pay (WTP) and patients' perceptions of importance of resolving menopausal symptoms, their satisfaction with physician services, their perceptions of pharmacists' abilities, and income. METHODOLOGY: A convenience sample of 203 adult women using medications to treat menopause was recruited by their pharmacists. A self-administered survey was used to address the study objectives. The contingent valuation method was used to assess WTP in 4 scenarios (ie, 50% and 100% improvement in symptoms after a half-hour initial and a half-hour follow-up visit, respectively). Logistic regression analyses were used to assess the relationship between WTP and the independent variables. RESULTS: Two hundred and three surveys were returned resulting in a response rate of 41%. Across all 4 scenarios, at least 85% of women surveyed were willing to pay a minimum of 20 US dollars for pharmacist-provided menopause and hormone replacement therapy services. Respondents were willing to pay a median of 40 US dollars (for both 50% and 100% improvement) per half-hour for initial consultations, and 20 US dollars and 40 US dollars (50% and 100% improvement, respectively) per half-hour for follow-up consultations. Regression analyses revealed that across all 4 scenarios, patients' perceptions of pharmacists' abilities and income were significantly and positively (P < .05) related to WTP for menopause and hormone replacement therapy counseling. CONCLUSION: This study showed that most women surveyed were willing to pay for pharmacist-provided hormone replacement therapy and menopause counseling services and that the WTP amounts increased as patients' perceptions of pharmacists' abilities and income increased. If pharmacists can effectively educate the public about their capabilities and expertise, they may discover that they have a new niche opportunity.

Female↗
PubMed2006

Willingness to pay for reducing fatal risk by improving air quality: a contingent valuation study in Chongqing, China.

In China, 76% of all energy comes from coal consumption, which is the major cause of air pollution. One of the major barriers to developing sound policies for controlling air pollution is the lack of information related to the value of the health consequences of air pollution. We conducted a willingness-to-pay (WTP) study using contingent valuation (CV) methods in Chongqing, China to estimate the economic value of saving one statistical life through improving air quality. A sample of 500residents was chosen based on multistage sampling methods. A face-to-face household interview was conducted using a series of hypothetical, open-ended scenarios followed by bidding game questions designed to elicit the respondents' WTP for air pollution reduction. The Two-Part Model was used for estimations. The results show that 96% of respondents were able to express their WTP. Their mean annual income is $490. Their WTP to save one statistical life is $34,458. Marginal increases for saving one statistical life is $240 with 1year age increase, $14,434 with 100yuan monthly income increase, and $1590 with 1year education increase. Unlike developed country, clean air may still be considered as a "luxury" good in China based on the estimation of income elasticity.

Air↗