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At least 649 records · Page 36Linked to original sources
PubMed2003

Willingness to pay and determinants of choice for improved malaria treatment in rural Nepal.

A logit model is used to estimate provider choice from six types by malaria patients in rural Nepal. Patient characteristics that influence choice include travel costs, income category, household size, gender, and severity of malaria. Income effects are introduced by assuming the marginal utility of money is a step function of expenditures on the numeraire. This method of incorporating income effects is ideally suited for situations when exact income data is not available. Significant provider characteristics include wait time for treatment and wait time for laboratory results. Household willingness to pay (wtp) is estimated for increasing the number of providers and for providing more sites with blood testing capabilities. Wtp estimates vary significantly across households and allow one to assess how much different households would benefit or lose under different government proposals.

Adult↗
PubMed2004

Informal payments for health care in transition economies.

There is considerable evidence that unofficial payments are deeply embedded in the markets for health care in transition countries. Numerous surveys indicate that these payments provide a significant but possibly distorting contribution to health care financing. Unofficial payments can be characterised into three groups: cost contributions, including supplies and salaries, misuse of market position and payments for additional services. There is evidence from across the region on the presence of payment in each category although it is often difficult to distinguish between payment types. Regulatory policy must address a number of issues. Imposing penalties may help to reduce some payments but if the system is simply unable to provide services, such sanctions will drive workers into the private sector. There appears to be some support for formalising payments in order to reduce unofficial charges although the impact must be monitored and the danger is that formal fees add to the burden of payment. Regulation might also attempt to increase the amount of competition, provide information on good performing facilities and develop the legal basis of patient rights. Ultimately, unless governments address the endemic nature of payments across all sectors, policy interventions are unlikely to be fully effective.

Cost Sharing↗
PubMed2004

Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan.

Most countries of the Former Soviet Union (FSU) have either initiated or are contemplating reform of the health sector. With negative real income growth and falling government revenues, a key concern of many governments is to secure additional finance through non-budgetary sources such as hypothecated payroll taxes, voluntary insurance, and increased private finance through patient cost-sharing. However, before such reforms can be considered, information is needed both on the current levels and distribution of household expenditures on health care, and the extent to which increased charges may affect access to health services, especially amongst the poor. This paper uses the Tajikistan Livings Standard Survey to investigate the level and distribution of out-of-pocket payments for health care in Tajikistan and to examine the extent to which such payments act as barriers to health-care access. The data show that there are significant differences in health-care utilisation rates across socio-economic groups and that these differences are related to ability to pay. Official and informal payments are acting both to deter people from seeking medical assistance and once advice has been sought, from receiving the most appropriate treatment. Despite informal exemptions, out-of-pocket payments for health care are exacting a high toll on household welfare with households being forced to sell assets or go into debt to meet the costs of care. Urgent action is needed to ensure equity in access to health care.

Adolescent↗
PubMed2004

Risk segmentation and equity in the Chilean mandatory health insurance system.

For decades, the Chilean health system has included a requirement for dependent workers to spend a certain percentage of their wages on health insurance. Since 1981, workers have been able to choose between public insurance and several private insurance providers. The reforms introduced more choice, moving away from reliance on an exclusive public provider. By 1999, about half of the country's active dependent workers had opted out of the public and into the private insurance system. The development of the private insurance system has been accompanied by controversy, however, regarding possible inequities in the utilization of medical services, the degree of risk segmentation, inefficiencies in the system's operation, and other factors. This paper discusses the issues of risk segmentation and equity. It starts by reviewing the system's design on a theoretical level, then deriving hypothesis and finally providing empirical evidence regarding these hypothesis. Particular attention is given to the issues of how individuals choose between the public and private system (to determine the reasons behind risk segmentation) and the differences in utilization among the various income groups (to clarify the issue of possible inequities).

Actuarial Analysis↗
PubMed2004

Did the distribution of health insurance in China continue to grow less equitable in the nineties? Results from a longitudinal survey.

This paper examines changes in the distribution of health insurance across socioeconomic groups in China over the 1989-1997 period. The analysis is based on the China Health and Nutrition Survey (CHNS), a unique micro-level longitudinal survey of households in eight Chinese provinces. Findings indicate that while aggregate insurance coverage rates in the sample changed little over this period, certain previously noted differences in coverage rates across socioeconomic groups narrowed significantly. These findings bring into question the presumption that continued market-oriented reform would lead to increased differences in coverage across those groups. The results, in fact, suggest exactly the opposite, that as the market oriented changes have occurred important disparities in health insurance coverage have been reduced. If these reductions are occurring there are important implications for policy. The groups normally targeted for equity reasons seem to be making progress over time but continued improvements are needed for these groups to reach the levels of coverage enjoyed by more fortunate subgroups.

Adolescent↗
PubMed2004

A direct method for estimating the compensating income variation for severe headache and migraine.

A subjective quality of life measurement method is introduced to calculate the compensating income variation for diseases and handicaps. This approach avoids some of the limitations of existing methods. The method is based on the direct measurement of life satisfaction of individuals. We apply the method to severe headache and migraine. It is found that severe headache and migraine have a large effect on well being and that the compensating income variation for severe headache and migraine is substantial.

Adult↗
PubMed2004

Criterion and content validity of a novel structured haggling contingent valuation question format versus the bidding game and binary with follow-up format.

Contingent valuation question formats that will be used to elicit willingness to pay for goods and services need to be relevant to the area they will be used in order for responses to be valid. A novel contingent valuation question format called the "structured haggling technique" (SH) that resembles the bargaining system in Nigerian markets was designed and its criterion and content validity compared with those of the bidding game (BG) and binary-with-follow-up (BWFU) technique. This was achieved by determining the willingness to pay (WTP) for insecticide-treated nets (ITNs) in Southeast Nigeria. Content validity was determined through observation of actual trading of untreated nets together with interviews with sellers and consumers. Criterion validity was determined by comparing stated and actual WTP. Stated WTP was determined using a questionnaire administered to 810 household heads and actual WTP was determined by offering the nets for sale to all respondents one month later. The phi (correlation) coefficient was used to compare criterion validity across question formats. The phi coefficients were SH (0.60: 95% C.I. 0.50-0.71), BG (0.42: 95% C.I. 0.29-0.54) and the BWFU (0.32: 95% C.I. 0.20-0.44), implying that the BG and SH had similar levels of criterion-validity while the BWFU was the least criterion-valid. However, the SH was the most content-valid. It is necessary to validate the findings in other areas where haggling is common. Future studies should establish the content validity of question formats in the contexts in which they will be used before administering questionnaires.

Attitude to Health↗
PubMed2004

Reforming health care financing in Bulgaria: the population perspective.

Health financing reform in Bulgaria has been characterised by lack of political consensus on reform direction, economic shocks, and, since 1998, steps towards social insurance. As in other eastern European countries, the reform has been driven by an imperative to embrace new ideas modelled on systems elsewhere, but with little attention to whether these reflect popular values. This study explores underlying values, such as views on the role of the state and solidarity, attitudes to, and understanding of compulsory and voluntary insurance, and co-payments. The study identifies general principles (equity, transparency) considered important by the population and practical aspects of implementation of reform. Data were obtained from a representative survey (n=1547) and from 58 in-depth interviews and 6 focus groups with users and health professionals, conducted in 1997 before the actual reform of the health financing system in Bulgaria. A majority supports significant state involvement in health care financing, ranging from providing safety net for the poor, through co-subsidising or regulating the social insurance system, to providing state-financed universal free care (half of all respondents). Collectivist values in Bulgaria remain strong, with support for free access to services regardless of income, age, or health status and progressive funding. There is strong support (especially among the well off) for a social insurance system based on the principle of solidarity and accountability rather than the former tax-based model. The preferred health insurance fund was autonomous, state regulated, financing only health care, and offering optional membership. Voluntary insurance and, less so, co-payments were acceptable if limited to selected services and better off groups. In conclusion, a health financing system under public control that fits well with values and population preferences is likely to improve compliance and be more sustainable. Universal health insurance appears to attract most support, but a broader public debate involving less empowered people is needed to resolve misunderstandings and create realistic expectations.

Adult↗
PubMed2004

The impact of information on non-health attributes on willingness to pay for multiple health care programmes.

Despite the acceptance that health gain is the most important attribute of health care, other aspects of health care may affect utility. The aim of this paper is to report an experiment to test the impact of providing different levels of information in the context of the EuroWill study, a joint contingent valuation (CV) of multiple health programmes. Three hundred and three respondents were simultaneously asked for their willingness-to-pay (WTP) for three health care programmes: more heart operations, a new breast cancer treatment and a helicopter ambulance service. To test for the impact of variation in information, three versions of one of the programmes (heart) were provided. Results show that WTP for all three programmes tended to be significantly higher for respondents who were provided additional positive information about the heart programme. Our results show that CV of health care programmes, which only take into account medical outcomes, may lead to the value of such programmes not being adequately estimated, and that the impact of information may even be more decisive in the context of joint evaluation of multiple, rather than single, programmes.

Adolescent↗
PubMed2004

Evaluating the effect of regulatory prohibitions against risk selection by health status on supplemental insurance ownership in Israel.

In Israel, supplemental insurance, which covers services not included in the mandatory basic benefits package, is offered by sick funds and regulated by the Ministry of Health. In 1998, policy regulations were set to eliminate barriers that prevented the ill from purchasing supplemental insurance, thereby increasing equality and risk solidarity. In this paper, we examine whether these regulations have indeed changed the extent of ownership and characteristics of policyholders, using data from surveys conducted in 1995, 1997, 1999, and 2001. The findings indicate that while there were no significant changes between 1995 and 1997, there was a significant increase in ownership among those with poor health status after the new regulations came into effect. We conclude that administrative regulations can influence the structure of supplemental insurance to achieve desired social values, and discuss additional policy options that are currently under debate in Israel to further promote equality and solidarity in this market by increasing accessibility to low income and other underserved populations.

Adult↗
PubMed1997

Does "process utility" exist? A case study of willingness to pay for laparoscopic cholecystectomy.

This paper is concerned with the concept of process utility in health care. The paper begins by outlining the reasons why it might be important to include process utility in health care evaluation. Problems in defining process and outcome are then outlined, after which the discussion turns to how process utility might be detected empirically. Willingness to pay (WTP) is suggested as one means of doing so. The methods and results of a survey to test for the existence of process utility using WTP applied to laparoscopic cholecystectomy are reported. Cholecystectomy patients on a hospital waiting list were asked about their WTP for laparoscopic rather than conventional cholecystectomy. Willingness to pay was used in two ways to examine whether process is in the utility function. First, respondents were randomly allocated to receive different descriptions of laparoscopic and conventional cholecystectomy; one group receiving a description of differences between the treatments in terms of outcomes only, whilst the other group received information on differences in the process of treatment as well as on differences in outcomes. The groups were then compared in terms of their WTP. Second, regression analysis was used to test for the association between WTP and respondents' ratings of reasons for their WTP, some of these reasons reflecting process aspects and others reflecting outcome aspects. The results lead to rejection of the hypothesis that information on process of care would lead to higher WTP. However, due to the design of the study and the difficulties in defining process and outcome, it cannot be concluded that process utility does not exist. The paper concludes by suggesting alternative methods of testing for the existence of process utility.

Analysis of Variance↗
PubMed1997

The poor pay more: health-related inequality in Thailand.

This paper examines the equality of utilization for equal need and equity of out-of-pocket expenditure for health services in a large urban area in Thailand. Data from a household health interview survey were used to explore patterns of perceived morbidity, utilization of various treatment sources, and out-of-pocket payment. Financial access to health care, as reflected in medical benefit/ insurance cover, appeared to influence reported illness and hospitalization rates. Gross lack of access to health care amongst lower socio-economic groups was not the main problem in this densely populated urban area because people could choose and use alternative health services according to their ability and willingness to pay. The corollary, however, was an inequitable pattern of out-of-pocket health expenditure by income quintile and per capita. The underprivileged were more likely to pay out of their own pocket for their health problems, and to pay out of proportion to their household income when compared with more privileged groups. Furthermore, the underprivileged were least likely to be covered by government health benefit schemes, in contrast in particular to civil servants, who paid less out of pocket and did not contribute to their medical benefit fund. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Policy options for the short and long term to improve the equity of payment systems for health care are discussed.

Financing, Personal↗
PubMed1997

Willingness to pay for antihypertensive care: evidence from a staff-model HMO.

Willingness to pay (WTP) has been used in Sweden to evaluate the value of antihypertensive therapy. The Swedish studies indicate that hypertensive patients are willing to pay between $107 and $120 per month for their therapy. We conducted a similar study in a population of hypertensive patients in a large, staff-model, managed care organization (Group Health Cooperative of Puget Sound). Participants returned a postal survey containing a WTP question with 10 "bids" ranging from $25 to $250. Respondents recorded whether they would accept or reject each bid at the stated dollar value. Demographic information such as age, income, and perceived health status was also collected. Results were analyzed with ordinary least squares regression, controlling for the demographic data. The estimated parameters were significant and indicated an adjusted mean WTP of $93 per month for antihypertensive therapy. The close similarity of the Swedish and U.S. results appears to support the use of WTP as a measure of health state preferences.

Age Factors↗
PubMed1997

Household cost of seeking malaria care. A retrospective study of two districts in Ghana.

Although malaria or fever (as it is commonly referred to) is a major cause of morbidity and mortality in Ghana, the cost of treating the disease in the country has not been well documented. Knowledge about the cost of treating malaria can affect the health care seeking behaviour of people and justify increased expenditure for malaria control. This study used data collected from 1289 households in two districts in Ghana to estimate the direct and indirect costs of malaria treatment. Malaria was ascertained not by parasitological tests but through symptoms described by the respondents using a recall period of one month. It was found that substantial amount of time was spent in seeking malaria care and taking care of the sick, which makes the indirect cost per case of fever represent 79% of the total cost of seeking treatment in the survey area. The results provide ample economic justification for malaria control. The average cost of treating an episode of the disease including direct costs and the opportunity costs of travel and waiting time amounted to $8.67 or 3.7 days of male output or 4.7 days of female output. When compared with the average five days loss of output for the patient due to malaria morbidity and caretaking, it can be concluded that the cost of controlling malaria is lower than lost earnings or the value of output.

Absenteeism↗
PubMed1998

Health and health expenditures in adjusting and non-adjusting countries.

The focus of this study is on the impact of World Bank structural adjustment operations on health expenditures and outcomes. We compare trends and levels of real per capita public spending on health, private consumption (which is the resource base for private health expenditures), and groupings child mortality indicators in four groups of countries. These are: (i) countries that started to borrow for the adjustment process early--Early Adjustment Lending (EAL) countries, (ii) Other Adjustment Lending (OAL) countries, (iii) Non-Adjustment Lending countries whose economies grew during the period 1985-1990 (NAL+), and (iv) Non-Adjustment Lending countries whose economies did not grow (NAL-). The NAL- group provides a 'counterfactual' for comparison with the two groups of adjusting countries. The results show that the fear about possible declines in health care spending in adjusting countries is unwarranted for EAL countries, that is those countries that started the adjustment process early and took it seriously. Government spending on health care increased on average for this group of countries, as did private consumption levels. Government health care expenditures also continued to increase in OAL countries, but mixed GDP growth performance has left little room for increased private spending. However, those countries that showed negative growth in the late eighties and did not start an adjustment process, fared worse throughout: real per capita public health care spending declined during the late eighties and increased less than in the other countries during 1989-1993, while private consumption has declined steadily. The trends in child mortality indicators show tremendous and continuing progress during the past two or three decades with few discernible differences among the four country groupings.

Child↗
PubMed1999

The social security scheme in Thailand: what lessons can be drawn?

The Social Security Scheme was launched in 1990, covering formal sector private employees for non-work related sickness, maternity and invalidity including cash benefits and funeral grants. The scheme is financed by tripartite contributions from government, employers and employees, each of 1.5% of payroll (total of 4.5%). The scheme decided to pay health care providers, whether public or private, on a flat rate capitation basis to cover both ambulatory and inpatient care. Registration of the insured with a contractor hospital was a necessary consequence of the chosen capitation payment system. The aim of this paper is to review the operation of the scheme, and to explore the implications of capitation payment and registration for utilisation levels and provider behaviour. A key weakness of the scheme's design is suggested to be the initial decision to give employers not employees the responsibility for choosing the registered hospitals. This was done for administrative reasons, but it contributed to low levels of use of the contractor hospitals. In addition, low levels of use were also probably the result of the potential for cream skimming, cost shifting from inpatient to ambulatory care and under-provision of patient care, though since monitoring mechanisms by the Social Security Office were weak, these effects are difficult to detect conclusively. Mechanisms to improve utilisation levels were gradually introduced, such as employee choice of registered hospitals and the formation of sub-contractor networks to improve access to care. A beneficial effect of the capitation payment system was that the Social Security Fund generated substantial reserves and expenditures on sickness benefits were well stabilised. The paper ends by recommending that future policy amendments should be guided by research and empirical findings and that tougher monitoring and enforcement of quality of care standards are required.

Capitation Fee↗
PubMed1999

Valuing the benefits of publicly-provided health care: does 'ability to pay' preclude the use of 'willingness to pay'?

The case against the use of willingness to pay (WTP) methods to value the benefits of publicly-provided health care is often made on the basis that WTP is associated with ability to pay. In this paper, it is demonstrated that this argument is not so straightforward, depending on two criteria: (a) the association of people's preferences with ability to pay and (b) the disparities of WTP for given options within categories of ability to pay. A method of dealing with ability to pay, based on these criteria, is proposed and illustrated through the use of data from a case study.

Attitude↗
PubMed1996

Economic analysis and its application to oral and maxillofacial surgery.

PURPOSE: Recent clinical publications have increasingly emphasized comparison of cost with benefits in such areas such as drug therapies, surgical procedures, and prophylaxis regimes within certain populations. In the past, cost analysis was based principally on the comparative market price of new treatment compared with standard therapy. Benefits were assessed solely in terms of objective clinical and imaging improvement. Now, issues such as quality of life, early return to occupation, and subjective symptoms of pain and discomfort caused by a treatment are also being critically evaluated. Addressing these latter issues, however, is often complicated and expensive. This article reviews some terms and principles of cost analysis, cost effectiveness, and cost-benefit analysis. Examples are given of recent attempts to quantify costs and benefits for individuals, hospitals, health organizations, and society as a whole. Guidelines are suggested concerning how these studies can be applied to oral and maxillofacial surgery.

Cost of Illness↗