Eliciting preferences for collectively financed health programmes: the ‘willingness to assign’ approach

Improving public involvement in health system decision making stands as a primary health policy goal. However, still limited guidance is available on how best to elicit preferences for health care programmes. This study examines a contingent choice technique to elicit preferences among health programmes, and named ‘willingness to assign’ (WTAS). WTAS reveals relative (monetary-based) values of a set of competing public programmes under a hypothetical healthcare budget assessment. Experimental evidence is reported from a deliberative empirical study valuing ten health programmes in the context of the Catalan Health Service. Evidence from this experimental study reveals that within the context of multiple programmes, preferences are internally more consistent and slightly less affected by ‘preference reversals’ as compared to values revealed from an adapted technique eliciting the willingness to pay (WTP) extra taxes. Another finding suggests that although programmes promoting health received the higher relative valuation, those promoting other health benefits were valued highly.     

Marginal WTP and Distance Decay: The Role of ‘Protest’ and ‘True Zero’ Responses in the Economic Valuation of Recreational Water Quality

We evaluate the sensitivity of distance decay in individuals’ stated willingness to pay (WTP) for water quality improvements in eutrophied lakes. We extend the standard model of contingent valuation (CV) by allowing individuals to adopt a sequential evaluation process consisting of two decision stages. In the first stage respondents decide whether they are ‘protesters’, have a WTP   \(=\)   ‘true zero’ or a \(\hbox {WTP}>0\) . Conditioned on a strictly positive WTP, we use Lee’s selectivity-corrected model to determine the magnitude of their WTP in the second stage. Using CV survey data from Norway we find significant distance decay in the first stage classification of respondents as ‘protesters’, ‘true zero’ WTP, or positive WTP. In the second stage model for positive WTP responses, we find little or no significant relationships when correcting for selection. Results suggest that previous findings of significant distance decay in contingent valuation of lake and river water in Europe may be driven by the definition of ‘protest’ and ‘true zero’ respondents. We find that WTP for water quality may be more useful as a qualitative indicator of political support for user financed water quality measures, than as a cardinal measure of marginal utility of water quality improvements.     

Energy efficiency and heating technology investments: Manipulating financial information in a discrete choice experiment

We elicit homeowners’ willingness to pay (WTP) for energy efficiency and low-carbon technologies in the context of heating appliance replacement. We employ a within-between subject design that involves manipulating information in a two-stage discrete choice experiment (DCE) and use WTP space estimation to identify the role of financial information in reducing fossil fuel use. We find that homeowners’ average valuation of energy efficiency exceeds associated heating cost savings, suggesting that they also consider non-monetary benefits when evaluating this type of investment, whereas information about private and pro-social benefits of investments only has a limited impact on WTP. Evidence also suggests that homeowners have a strong preference for the existing technology. Consequently, fossil fuel users’ WTP for switching to low-carbon technologies does not cover respective investment cost differentials, and we derive evidence on how combined subsidies and information can induce these users to opt out of fossil technologies.     

HETEROGENEITY IN WILLINGNESS‐TO‐PAY FOR THEATRE PRODUCTIONS: INDIVIDUAL SPECIFIC WILLINGNESS‐TO‐PAY ESTIMATES FOR THEATRES,SHOWS AND THEIR ATTRIBUTES

This paper investigates people's preferences for live theatre, and heterogeneity in willingness‐to‐pay (WTP). A stated preference discrete choice model estimates utility and WTP for different attributes of theatre productions. Previous studies assumed fixed coefficients across all theatre‐goers. This study allows coefficients of attributes to vary across individuals in the population, providing information on the heterogeneity of tastes. Theatre‐goers' choices are used to estimate individual‐based parameters for a person's tastes in theatre productions. The analysis reveals the heterogeneity of tastes for different types of plays and ticket price; and the significance of ‘reviews’ by critics and ‘word of mouth’ opinions as important variables determining choice.     

Measuring Stigma: The Behavioral Implications of Disgust

Stigmatization of products and technologies can lead to large monetary losses even when there are no associative risks. This paper reports on experiments that provide insight into the behavioral responses of disgust from an economic perspective. We use a dead sterilized cockroach to ‘contaminate’ drinking water and generate willingness-to-pay (WTP) and willingness-to-accept (WTA) measures of participants’ reactions. These results are contrary to previous results from research not involving financial incentives, as most participants’ WTP and WTA values are near zero for drinking cockroach contaminated water. Additionally, filtration of cockroach water leads participants to become significantly more likely to request compensation compared to spring water, but it does not result in requesting significantly more money to drink it. Finally, WTP and WTA differences can be explained by participants’ decision on whether or not to request compensation and not by the amount of compensation.     

The impact of behavioural risk-reduction interventions on willingness to pay to avoid sexually transmitted infections: a stated preference study of justice-involved youth

Risky health behaviours, such as smoking, drinking and risky sex, are substantial contributors to the U.S. morbidity rates and healthcare costs. While economic models typically regard preferences as stable, a growing literature suggests that information, including how it interacts with intentions and attitudes, plays an important role in unhealthy behaviours. Relatedly, a large health literature demonstrates that theory-based behavioural interventions can successfully change risky behaviour. This study uses the contingent valuation (CV) survey method to investigate the impact of behavioural interventions on a novel outcome measure: the willingness to pay (WTP) to avoid the consequences associated with risky behaviour. Using novel pre- and post-intervention data from Project MARS (Motivating Adolescents to Reduce Sexual Risk), this study estimates the impact of the intervention on elicited WTP to avoid sexually transmitted infections (STIs). It is found that after the intervention, participants’ elicited WTP to avoid STIs were significantly higher, and more sensitive to differences in infection severity. These results suggest that the intervention may affect risky sexual behaviour by changing the perceived value of avoiding the consequences of risky sexual behaviour. Additionally, these findings contribute to an ongoing debate regarding the construct validity of CV studies in health economics.     

Willingness to pay for other species' well-being

Benefit-cost analysis of environmental policies typically focuses on benefits to human health and well-being. For other species, economists have attempted to measure human WTP for changes in the numbers of individuals for different types of wildlife, and to preserve biodiversity. When it comes to humans' WTP for improvements in the quality-of-life for other species, however, the evidence is limited. Morbidity and quality-of-life considerations may be particularly important to the task of valuing non-fatal harm to wildlife in the wake of an environmental disaster. We argue that the other species morbidity-reduction component of WTP should be calculated net of any “outrage” component associated with the cause of the harm. This net WTP is likely to be correlated with the premium that people are willing to pay for chicken products from birds for which the quality-of-life has been enhanced by improved animal welfare measures. This paper uses a conjoint choice stated preference survey to reveal the nature of systematic heterogeneity in preferences for “humanely raised” versus “conventionally raised” chicken. We also use latent class analysis to distinguish between two classes of people—those who are willing to pay a premium for humanely raised chicken, and those who are not.     

Not everybody prefers organic food: unobserved heterogeneity in U.S. consumers’ preference for organic apple and milk

Despite organic food’s growing market share and the often-found premiums for organic foods in willingness-to-pay studies, the ultimate size of the organic food market remains unclear. Due to perceived taste, safety or appearance, some people may, in fact, not prefer organic. This study uses data from choice experiments to determine preference for organic versus conventional milk and apples. Using latent class and random parameter models, nontrivial shares (at least 33%) of consumers in both markets are not willing to pay a premium for organic. These results have implications for food marketers but also for economists modelling the organic food sector, which typically assume vertical differentiation.     

Spatial Heterogeneity of Willingness to Pay for Forest Management

The paper investigates the spatial heterogeneity of public’s preferences for the implementation of a new country-wide forest management and protection program in Poland. Spatial econometric methods and high resolution geographical information system data related to forest characteristics are used to explain the variation in individual-specific willingness to pay (WTP) values, derived from a discrete choice experiment study. We find that respondents’ WTP is higher the closer they live to their nearest forest, and the scarcer forests are in the area where they live. Interestingly, the higher the ecological value of forests in respondents’ area, the more people prefer extending areas of national forest protection. We also investigate spatial patterns in individual-specific WTP scores and in latent class membership probabilities, finding that preferences are indeed spatially clustered. We argue that this clustering should be taken into account in forest management and policy-making.     

Willingness to pay for publicly-financed health care: how should we use the numbers?

This paper addresses the question of how willingness to pay (WTP) values in health care evaluation can be used by policy makers. The way in which WTP values are used depends on from whom values are elicited and whether the good concerned is privately-financed or publicly-financed through taxation. Thus, four possible uses of WTP values are identified. The focus is on the two uses which arise in the publiclyfinanced situation. ‘Conventional’ use of WTP values, where the decision as to whether or not to provide a service depends upon whether or not WTP values are greater than total cost, applies only in the privately-financed, and not publiclyfinanced situations. The situations with publicly-financed goods are more complex. The use of WTP values for publicly-financed goods is justified and illustrated.     

Food Prices Policy in Israel: A Strategic Instrument

Abstract:

The goal of this research is to demonstrate a significant importance of state policy of food prices supervision in Israel. The article begins with a detailed discussion of the healthy food basket’s components, based on the Israeli Ministry of Health recommendations. Next, we present the prices of the goods included in the basket, and a calculated estimate of the per capita cost of funding the basket. Based on this cost figure, we assess the economic ability of Israeli households to purchase the basket. The results show that two lowest quintiles would have trouble paying the price of a basic health food basket. Further, it describes the food prices in Israel and its significance, Israel’s food market and the major regulatory tools associated with the food market. In the end, we define the need for short-term and longer-term regulation of food costs, and the necessity of expanding competition in the food market.     

Measuring heterogeneity,survey engagement and response quality in preferences for organic products in Nigeria

The identification of the market potentials of organic products is important in the drive towards a sustainable agricultural development in sub-Saharan Africa (SSA). However, available evidence shows that valuing attributes of credence goods (such as organic products) while using stated preference methods faces additional obstacles compared to other normal goods. In this study, we examine consumers’ preferences and willingness-to-pay (WTP) for health and environmental attributes of organic products in Nigeria. We employ an approach that allows us to adequately capture the value of organic products by linking part of the heterogeneity across respondents to differences in scale, while making use of indicators of survey engagement, without risks of endogeneity bias and measurement error that arise from the deterministic methods. The empirical results show that market for organic products exists in Nigeria, with reduction in pesticide residues attribute attracting the highest value, followed by the certification programme. Furthermore, we observe that increases in the latent engagement variable lead to a greater probability of agreement with statements relating to survey understanding and realism, and hence more substantive output.     

An evening at the theatre: using choice experiments to model preferences for theatres and theatrical productions

This article examines people's preferences and demand for live theatre. It investigates the preferences for people attending a regional theatre, Northern Stage in Newcastle, in relation to other live theatres they could attend, and in relation to the attributes of theatrical productions and ticket price. It uses a Stated Preference (SP), discrete choice experiment, to assess people's utility and Willingness To Pay (WTP) for the different attributes of theatrical productions. The model assesses the effect of the attributes of plays on choice; and the impact of Socio-Economic (SE) and demographic variables on choice and demand. Results reveal the heterogeneity of theatregoers’ tastes for different types of plays and ticket prices. The models reveal the significance of ‘reviews’ and ‘Word Of Mouth’ (WOM) opinions on plays, as the most important variables determining choice.     

Feeding (On) Geopolitical Anxieties: Asian Appetites,News Media Framing and the 2007–2008 Food Crisis

This paper analyses the role of news media in (re)producing geopolitical narratives of food insecurity in relation to the 2007–2008 global food price spike. News content and textual analysis suggests that the media’s representation of the food price spike is partly framed by Western geopolitical anxieties of the ‘threatening rise of Asia’, and features ‘fast growing’ Asian appetites among the main culprits of the crisis. Seeking to explain the widespread circulation of such representation, this paper analyses media-source relationship within the context of market-driven journalism, and suggests that the changing role of news media has in turn contributed to a rapid and uncritical circulation of elite-based interpretation of, and neoliberal geopolitical approach to, food security. The paper points at the importance of critical enquiries into geopolitical representations of food insecurity and of opening media space for a ‘counter-geopolitics of food security’.     

On generic vs. brand promotion of farm products in foreign markets

Farm groups and their governments spend millions of dollars each year advertising agricultural products in international markets. Intuitively, country-of-origin or ‘brand’ advertising should be more profitable than generic advertising in that it enhances product differentiation and reduces free riding. However, unlike generic advertising, brand advertising decreases the demand for competing imports and lowers their prices when supplies are upward sloping. In addition to inviting retaliation, the decline in the prices of competing products erodes the price of the advertised product through second-round or ‘market feedback’ effects. In this study, we develop a generalized model for assessing the relative effectiveness of generic and brand promotion in the international market when products are differentiated by source origin and supplies are uncontrolled. Applying the model to US beef promotion in Japan, we find that when brand and generic advertising are equally efficient in the sense that they cause equivalent horizontal shifts in the group and product-specific demand curves, generic advertising is indeed more profitable for most of the relevant parameter space. Distributional analysis suggests that, with equal export supply elasticities, the gross benefits of generic advertising are distributed across exporters in proportion to the expenditure elasticities for the products in question.     

WILLINGNESS TO PAY FOR AIR QUALITY: THE CASE OF OUTDOOR EXERCISE

This study uses a contingent valuation (CV) survey to establish a sample of outdoor exercisers' willingness to pay (WTP) for ambient air quality improvements in East Baton Rouge parish, Louisiana. Estimated annual median and mean WTP values are £95 and £191, respectively, per person per year for assurance that ozone levels would not become "unhealthful" on any day. The survey informed respondents that in the prior year the local community experienced 14 days on which ozone levels exceeded federal standards. The study makes the strong assumptions that respondents believed they were "buying" 14 more healthy days and that WTP per day "bought" is constant. Given these assumptions, one can scale this WTP response to represent annual medians and means of approximately £7 and £14 per person per day, respectively. An econometric procedure for generalizing the community's annual WTP to avoid the 14 unhealthful days yields estimates ranging from £3.21 and £5.36 per person per healthy day, or between £12.4 and £20.6 million per year. The unit day estimates are comparable to CV and household production finction estimates of WTP in the Los Angeles basin, suggesting their usefulness for benefits transfer .     

Willingness to pay for QALY: perspectives and contexts in Japan

Abstract

Objectives: Theoretically, willingness-to-pay (WTP) for quality-adjusted life years (QALY) can vary depending on social and personal preferences and on ex-ante and ex-post settings. However, empirical investigations into the theoretical differences are lacking. In Japan, setting the threshold has been controversial since a pilot project to implement health technology assessments (HTA) launched in 2016. The study aim is to estimate WTP values for one additional QALY from different perspectives, health statuses, and contexts to confirm the difficulty in setting a uniform price threshold using WTP.

Methods: More than 1,000 respondents representing a cross-section of the Japanese population answered each of nine questionnaire decks in an online panel. WTP values were estimated on three different perspectives (personal, social, and socially inclusive) and on two contexts (ex-ante and ex-post). This study primarily used the non-parametric spike model based on double-bounded dichotomous choice (DBDC) settings to obtain the conditional WTP values.

Results: WTP per QALY was higher in the severe health status than in the moderate health status from all perspectives. Respondents from the socially inclusive perspective estimated the highest WTP value for a new drug. Respondents were also asked about life-threatening diseases in ex-post and ex-ante. The WTP value in ex-ante was higher than in ex-post, and demographic factors affecting the WTP were different in both situations. The various WTP values were obtained from these surveys.

Limitations: The analysis was based on data collected from an internet panel, which could be biased. There is also a risk that respondents answered the questionnaire differently if asked in everyday situations.

Conclusion: Use of a uniform price threshold may not be appropriate in policy settings, because it may not reflect diverse preferences based on different situations, such as disease type and severity. Setting a price threshold as Japan institutes an HTA system requires further research.     

The social acceptability and valuation of recycled water in Crete: A study of consumers' and farmers' attitudes

This paper investigates the Willingness to Use (WTU) and Willingness to Pay (WTP) for recycled water in agriculture. We report results from surveys of farmers and consumers on the island of Crete, Greece. Crete is suffering from an increasingly severe water shortage coupled with declining groundwater supplies, therefore the wider use of recycled water is an important policy priority. We have investigated WTU and WTP for two crops with two different levels of water treatment. The mean WTP for 1 cm³ of recycled water was 0.15€ for the irrigation of both olive trees and tomato crops, namely 55% of the fresh water price. The mean WTP for olive oil produced from olive trees irrigated with recycled water was 2.65€, namely 88% of its current market price. We have found that both attitudinal factors, such as environmental awareness and economic factors, such as freshwater prices and incomes, are significant in explaining the WTU and WTP for recycled water and products produced using it, but that important differences exist between farmers and consumers.     

Contribution of intangible costs to the economic burden of multiple sclerosis

Abstract

Background:

Multiple sclerosis (MS) is associated with a substantial economic burden resulting from direct medical costs associated with health and disability-related resource utilization and indirect costs relating to reduced productivity. However, reduced health-related quality of life (HR-QOL) may be associated with additional costs, often termed ‘intangible costs,’ that should be considered as part of the economic burden from the societal or patient perspectives.

Objectives:

To review the contribution of intangible costs to the overall economic burden of MS.

Methods:

Medline was searched through March 2010 for relevant articles that included the terms ‘multiple sclerosis’ in combination with ‘intangible costs,’ ‘QALY,’ ‘quality-adjusted life year,’ ‘willingness-to-pay,’ and ‘WTP.’ Other than the restriction that the articles were published in English, there were no other exclusionary criteria for the search. Identified references were hand-searched to determine if intangible costs were estimated.

Results:

Thirteen studies across ten countries were identified that estimated intangible costs based on the number of quality-adjusted life-years (QALYs) lost due to a reduction in HR-QOL multiplied by accepted willingness-to-pay (WTP) thresholds. Although absolute costs varied depending on thresholds used and year of evaluation, the intangible costs accounted for 17.5–47.8% of total costs of MS. Furthermore, evidence suggested intangible costs are positively correlated with worsening disability. The largest increase in intangible costs occurred at the transition between mild and moderate disability. However, since no value has been established as being acceptable to pay for a QALY, a limitation of these studies was their dependence on the definition of the WTP threshold.

Conclusions:

Intangible costs substantially add to the economic burden of MS. There is not only a need to further characterize these costs and incorporate them into economic studies, but also to determine how these costs can be reduced through appropriate management strategies.     

Product differentiation in the German soft drink market: which attributes matter?

In this study, we apply a hedonic pricing model to a unique data set of the German carbonated soft drink market. We distinguish between traditional brands and private label brands and include a variety of product attributes such as flavour, sugar content and bottle size in our analysis. Our results show that most traditional brands yield highest price premiums. However, organic niche products seem to be even more profitable. Also, unconventional flavours, small bottle sizes and retailing in supermarkets lead to higher price premiums. Private label brands are associated with highest negative price premiums.