Skip to main content
Top

2003 | Book

The Contingent Valuation Method in Health Care

An Economic Evaluation of Alzheimer’s Disease

Authors: Sandra Nocera, Harry Telser, Dario Bonato

Publisher: Springer US

Book Series : Developments in Health Economics and Public Policy

insite
SEARCH

About this book

In the future, as our society becomes older and older, an increasing number of people will be confronted with Alzheimer's disease. Some will suffer from the illness themselves, others will see parents, relatives, their spouse or a close friend afflicted by it. Even now, the psychological and financial burden caused by Alzheimer's disease is substantial, most of it borne by the patient and her family. Improving the situation for the patients and their caregivers presents a challenge for societies and decision makers. Our work contributes to improving the in decision making situation con­ cerning Alzheimer's disease. At a fundamental level, it addresses methodo­ logical aspects of the contingent valuation method and gives a holistic view of applying the contingent valuation method for use in policy. We show all stages of a contingent valuation study beginning with the design, the choice of elicitation techniques and estimation methods for willingness-to-pay, the use of the results in a cost-benefit analysis, and finally, the policy implica­ tions resulting from our findings. We do this by evaluating three possible programs dealing with Alzheimer's disease. The intended audience of this book are health economists interested in methodological problems of contin­ gent valuation studies, people involved in health care decision making, plan­ ning, and priority setting, as well as people interested in Alzheimer's disease. We would like to thank the many people and institutions who have pro­ vided their help with this project.

Table of Contents

Frontmatter
Chapter 1. Introduction
Abstract
Health is valued as one of the most precious goods which led to claims for equal access to health care regardless of an individual’s ability to pay. For this reason industrialized countries deviate from the principles of a market economy in allocating health goods, even if they are otherwise organized through market principles. However, rising health care costs have led to a number of legislative measures which all had the objective of reducing the rate of increase in public health care expenditure. Besides the goal of equal access to health goods the efficiency goal has become equally important. Therefore, health care systems are challenged by determining the best way to allocate scarce resources among alternative uses (Sloan and Conover, 1995).
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 2. Study Design
Programs against Alzheimer’s Disease
Abstract
Alzheimer’s disease (AD) is one of society’s costliest diseases and it puts a heavy strain on patients and their caregivers. The demographic change in industrialized countries is expected to aggravate the situation substantially in the near future. Despite the fact that AD can not be cured until now, there are nevertheless several possibilities to ease the burden for AD patients and/or their caregivers. We elicit the preferences of the Swiss population for three possible health care programs dealing with AD. The first program tries to ease some of the strain on informal caregivers. In a second program we focus on early detection of AD which is required for existing therapies to be effective. In the last program research for curing AD will be intensified.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 3. Elicitation Methods
Abstract
The contingent valuation (CV) method is the most direct approach of the cost-benefit analysis which measures both resource costs and health benefits in monetary terms. In the CV method the monetary value of a (nonmarketed) good is determined by asking people about their willingness-to-pay (WTP) for the good under evaluation. Whereas in environmental economics the CV method has become the standard approach to elicit WTP for environmental goods, reluctance against valuing health effects in monetary terms is still widespread. In addition, it is criticized that WTP is difficult to measure and that it may be positively correlated with wealth or income (Pauly, 1995). Nevertheless, the interest for the CV method is growing in the health care field as well. Klose (1999) reviewed 67 health care studies, published before 1998, which meet the criteria of CV studies. He concludes that WTP is a more comprehensive effectiveness measure than other usually used measures (e.g., physical or utility measures), since it recognizes health as well as non-health benefits from health interventions. However, before results can be used with confidence in health care decision making, more research concerning the design of a CV study or the choice of the elicitation technique is still necessary.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 4. Estimation Methods
Abstract
This chapter focuses on the estimation methods we are using for the three elicitation techniques. Whereas the payment card (PC) method elicits maximum willingness to pay (WTP) more or less directly, discrete CV surveys like the dichotomous choice (DC) and the dissonance-minimizing (DM) format only obtain a discrete indicator instead of a direct measure of maximum WTP.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 5. Data
Abstract
In this section we present how the survey was conducted. In section 1 we describe how the sample is structured and how the data was gathered. Section 2 then shows the definition of the variables, their expected influence on willingness-to-pay (WTP), and their descriptive statistics.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 6. Results
Abstract
In this chapter we present the results for the three programs. We calculate several WTP values for every program due to the different elicitation (DC, DM, and PC) and estimation methods (parametric and nonparametric) used. We focus on mean WTP since it is most often used in the literature. However, a comparison with median WTP values can be found in chapter 7 section 1.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 7. Possible Reasons for Variation in the WTP Values
Abstract
Contingent valuation (CV) studies are often criticized for being too hypothetical and therefore eliciting wrong WTP values. Especially the discrete CV method is regarded as being inappropriate. It is true that there are still many unsolved problems in this respect. For example, it is not clear which welfare measure should be favored. This is of great significance since results differ if either mean or median WTP is chosen (see section 1). Furthermore, WTP values depend substantially on the chosen elicitation technique. The PC method, for example, elicits WTP values, which are two to five times smaller than WTPs of the DC method. A possible explanation can be found in the design of the DC method. By giving respondents only a yes/no response alternative, yea-saying and protest answers may be provoked. In section 2 we examine whether the DM method, which is designed to avoid yea-saying and to control for protest answers, elicits smaller WTP values than the DC method. Another drawback for CV studies is that there is enormous potential for manipulating results. Therefore, we test for question ordering and payment vehicle bias in sections 3 and 4. Furthermore, we analyze in section 5 to see whether and how changing the maximum bid influences mean WTP values of discrete CV studies. In sections 6 and 7 we examine whether warm glow or information bias is present.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 8. Cost-Benefit Analysis
Abstract
In this chapter we focus on policy implications resulting from our analysis. For this reason a cost-benefit analysis for each of the three AD programs is conducted to identify whether a program’s benefits exceed its cost. A posi-tive net social benefit indicates that a program is worthwhile. Benefits can be measured with two methods: the cost-of-illness (COI) and the willingness-to-pay (WTP) approach. The COI method approach tries to measure the social costs associated to a particular disease. Costs include direct costs (e.g., medical services) as well as indirect costs (e.g., loss of productivity, premature death). If a health program yields a reduction in illness, costs of medical expenditures and forgone earnings decrease. These cost savings are treated as the benefits of the health program. However, the COI approach does not measure intangible costs (e.g., pain and suffering), and therefore estimated benefits are a lower bound of a health program’s benefits. Contrary to the COI approach, the WTP method measures the value of a health program on how much individuals are willing to pay for it. The advantages of WTP are that it contains all utility components and is based on individuals’ preferences. We apply both methods to measure the benefits of the programs ’care’ and ’diagnosis’ in spite of the substantial disadvantages of the COI approach.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 9. Conclusions
Abstract
The aims of this study were to investigate whether claims for more intervention regarding AD can be justified economically and to study methodological problems in applying the contingent valuation method to measure people’s values for the outcome of health programs. Our main results are summarized in section 1. These findings contribute to the development of an economic standard procedure for the evaluation of health programs based on a CV survey. In section 2 we present a guideline on how to execute a CV study. However, we will not dive into how to ask a question or what questions should be asked. Interested readers are referred to, e.g., Mitchell and Carson (1989) or Fischhoff and Furby (1988). Instead, we will focus on the choice of the elicitation technique and estimation method.
Sandra Nocera, Harry Telser, Dario Bonato
Chapter 10. Appendix
Sandra Nocera, Harry Telser, Dario Bonato
Backmatter
Metadata
Title
The Contingent Valuation Method in Health Care
Authors
Sandra Nocera
Harry Telser
Dario Bonato
Copyright Year
2003
Publisher
Springer US
Electronic ISBN
978-1-4419-9133-1
Print ISBN
978-1-4613-4805-4
DOI
https://doi.org/10.1007/978-1-4419-9133-1