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PubMed2001

Psychosocial factors associated with the public's willingness to pay for genetic testing for cancer risk: a structural equations model.

An adaptation of Andersen's behavioral model of health services utilization is used to examine the psychosocial and socio-demographic factors that directly and indirectly influence the likelihood of undergoing genetic susceptibility testing for cancer, and the amount of money that individuals would be willing to pay out-of-pocket for such a test. Apart from willingness and likelihood, the model also included perceived benefits and barriers, perceived susceptibility, dispositional optimism, information seeking, family history of cancer, socioeconomic status (SES), and age, and explained 30.3% of the variation in willingness. We found as hypothesized that likelihood of undergoing such tests was central to understanding willingness to pay. Being aware of genetic susceptibility testing for cancer, and talking and seeking information about it was directly associated with an increased chance of being willing to pay more, independent of other indirect associations (effects). Interventions targeting those with a family history of cancer and those with a higher SES should generate more awareness about the potential positive and negative consequences to one's family of testing, and the interface between family history of cancer and perceived susceptibility. Interventions should also motivate people to talk and seek more information about genetic testing for cancer risk to enable them take well-informed decisions.

Adult↗
PubMed1997

The value and use of the Qualified Medicare Beneficiary Program: early evidence from Tennessee.

The Qualified Medicare Beneficiary (QMB) Program eliminated the out-of-pocket costs of obtaining health care services under the Medicare program for some low-income beneficiaries who were previously ineligible for Medicaid. The program is underused, and little is known about its effects. The article describes the QMB Program and compares program beneficiaries with others whose out-of-pocket payments are covered by Medicaid. Using Medicare claims data covering QMBs in Tennessee, we found that the program financed a relatively high rate of use of Medicare services and saved low-income Medicare beneficiaries hundreds of dollars per month in out-of-pocket costs. Social workers can promote the program and increase the use of its covered services appropriately, thereby by maximizing its potential benefits to low-income people.

Cost-Benefit Analysis↗
PubMed2005

How many social workers are needed in primary care? A patient-based needs assessment example.

This study measured levels of self-reported social need in a sample of 684 veterans seen in four primary care clinics of a large Veterans Affairs health care system, using the Social Needs Checklist, and calculated levels of social work staffing to meet these needs. Data were obtained on the presence and severity of 15 areas of social needs, housing status, patient requests for social work services, and current access to other providers for social services. Data were also obtained from primary care social workers who estimated the average time needed to provide basic social work services. Nearly two-thirds of the sample had problems related to finances and personal stress. Three in four patients reported multiple needs. One-third requested social work services. Social work staffing needed for highest acuity patients was estimated to be 61 percent higher than actual staffing available. The study presents a method of estimating staffing levels based on social needs reported by patients.

Humans↗
PubMed2004

What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality.

Treatment-related multiple pregnancy poses the biggest threat to the safety of IVF. Despite a double embryo transfer (DET) policy in most European centres, twin rates continue to be unacceptably high, at 20-35%. Elective single embryo transfer (SET) is an effective way to minimize twin pregnancies, but the debate surrounding its routine clinical use continues. A review of the literature was undertaken in order to seek evidence about the effectiveness of SET, and identify barriers to its acceptance in clinical practice. Data from randomized controlled trials (RCTs) indicate that SET results in lower live birth rates per fresh IVF cycle (odds ratio 0.53; 95% confidence interval 0.31-0.89; P = 0.02) in comparison with DET. Data on cumulative live birth rates are unavailable from RCTs, although the expectation is that these are comparable in the two groups. SET is unlikely to be suitable for all women undergoing IVF and outcomes may be sensitive to different laboratory protocols. The perceived effectiveness of SET is influenced by the way existing evidence is interpreted. Other factors affecting the routine use of SET include laboratory techniques, individual preferences and funding issues.

Embryo Transfer↗
PubMed1988

Ought the young make health care decisions for their aged selves?

Though the chief responsibility for providing for the health care of older Americans has been (and should remain) society's, there has been increasing interest in private solutions. Individual provision, however, would require not only adequate wealth but prudent planning, demanding in turn more discipline, self-control, and foresightedness than many individuals are normally capable of. One possible corrective is pre-commitment, a strategy of binding oneself to a plan chosen to allocate resources optimally over the life span. Though pre-commitment may have some important uses, however, it is far from clear that people should be encouraged or enabled to rely upon it for old-age health care planning. The present paper examines some of the philosophical and policy concerns attendant to the use of pre-commitment strategies for resource allocation in old age.

Aged↗
PubMed1997

Finance schemes for funding private orthodontic treatment.

Over the last ten years there has been a steady increase in the volume of private dental treatment and numerous finance schemes have been developed to help both patients and dentists. Private orthodontic treatment is increasing and the purpose of this article is to summarise the main features of the schemes currently available to fund private orthodontic treatment and to provide a source of reference.

Financing, Organized↗
PubMed1997

The lessons of user fee experience in Africa.

This paper reviews the experience of implementing user fees in Africa. It describes the two main approaches to implementing user fees that have been applied in African countries, the standard and the Bamako Initiative models, and their common objectives. It summarizes the evidence concerning the impact of fees on equity, efficiency and system sustainability (as opposed to financial sustainability), and the key bottlenecks to their effective implementation. On the basis of this evidence it then draws out three main sets of lessons, focusing on: where and when to implement fees; how to enhance the impact of fees on their objectives; and how to strengthen the process of implementation. If introduced by themselves, fees are unlikely to achieve equity, efficiency or sustainability objectives. They should, therefore, be seen as only one element in a broader health care financing package that should include some form of risk-sharing. This financing package is important in limiting the potential equity dangers clearly associated with fees. There is a greater potential role for fees within hospitals rather than primary facilities. Achievement of equity, efficiency and, in particular, sustainability will also require the implementation of complementary interventions to develop the skills, systems and mechanisms of accountability critical to ensure effective implementation. Finally, the process of policy development and implementation is itself an important influence over effective implementation.

Africa↗
PubMed2001

Contingency valuation and preferences of health states associated with side effects of antipsychotic medications in schizophrenia.

The purpose of this study was to investigate the construct validity and the test-retest reliability of the willingness to pay (WTP) method for estimating health state preferences associated with side effects of antipsychotic medication. Ninety-six schizophrenia patients on antipsychotics were asked (1) how much they would be willing to pay to get rid of side effects with 100 percent probability, (2) a standard gamble (SG) question measuring utilities of patient's health state associated with side effects, and (3) their WTP to get rid of side effects based on the utility found with SG. Patients were divided into three groups based on severity of side effects. There was a significant difference between side effect severity groups for (1) the utility associated with side effects (Kruskal-Wallis [K-W] chi-square = 8.48, p = 0.014), and (2) their WTP to get rid of side effects with either 100 percent probability (K-W chi-square = 14.32,p = 0.001) or based on the utility associated with side effects (K-W chi-square = 5.96, p = 0.051). There was a significant correlation between utility and the WTP based on utility (Spearman r = -0.42, p = 0.003). Because of a wide variation in side effects at the 1-month interval, we were unable to assess the test-retest reliability of SG and WTP. Our results suggest that WTP has some construct validity in valuating and measuring preferences of health states associated with side effects of antipsychotics in schizophrenia.

Adult↗
PubMed2000

Determinants of willingness to pay for hip and knee joint replacement surgery for osteoarthritis.

OBJECTIVES: To determine whether patients with osteoarthritis (OA) would be willing to pay for joint replacement and whether patient characteristics or health outcomes, including pain, physical function and health-related quality of life, were related to willingness to pay (WTP). METHODS: Patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR) for OA completed a disease-specific questionnaire (Western Ontario and McMaster: WOMAC index), a generic measure of health status (Medical Outcome Study Short Form-36: SF-36) and an Evaluation Questionnaire to measure WTP and satisfaction with the replacement. RESULTS: Responses were obtained from 109 (77%) THR patients and 129 (72%) TKR patients. Mean age of respondents was 67 yr for THR (47% female) and 73 yr for TKR (60% female). Overall, 85% of patients responded to the WTP question. Of the THR patients, 71% were willing to pay something, 11% were not willing to pay anything and 18% did not answer the question. For TKR patients these figures were 70, 16 and 14% respectively. However, of those who responded to the WTP question, only 25% of the THR patients and 18% of the TKR patients indicated they would be willing to pay the actual current average cost of the operation in Australia (>/= A$15 000). A lower postoperative pain score (as measured by the WOMAC index) was a significant predictor of WTP for both THR and TKR patients. Income also significantly predicted WTP in THR patients but not in TKR patients. The other significant predictors for TKR patients were older age, having private health insurance and willingness to recommend joint replacement to others. CONCLUSIONS: Willingness to pay was a measure that was understandable and acceptable to patients, most of whom were willing to pay something. There was a high correlation between WTP, good health outcomes and patient satisfaction, pain relief being the dominant determinant.

Aged↗
PubMed2005

Social Security.

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Family↗
PubMed1986

Relationship between expected indebtedness and career choice of medical students.

In this study the authors explored the relationship between medical students' expected indebtedness and their career choice. Based on responses by University of Rochester medical students to a questionnaire, the authors found that total indebtedness, which included family loans and academic loans, was positively related to expected future salary, post-training work mode (that is, private or government practice or academic), and anticipated career choice (general, specialty, or subspecialty). Reported academic indebtedness, however, was not by itself significantly related to these variables. The authors concluded that anticipated high levels of total indebtedness were related to the anticipation of high future income, an intention to enter subspecialty practice, and the expectation of practicing full-time. Implications of these relationships for the field of medicine are outlined.

Career Choice↗
PubMed1986

Career decisions.

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Career Choice↗