Shiell Alan, Gold Lisa
Department of Community Health Sciences, University of Calgary, Alberta, Canada.
Health Econ. 2003 Nov;12(11):909-19. doi: 10.1002/hec.777.
The use of willingness to pay to value the benefits of health care is increasing. Much of this work assumes that health preferences are well formed or 'complete' and readily revealed if the right question is asked in the right way. We examined this assumption, seeking evidence in a mixed-methods study that explored the meaning and implications of vague responses to a payment-scale based willingness to pay exercise.One-half of the sample said that their vagueness meant that their maximum willingness to pay was actually greater than the amount that they had previously said it was. Thirty percent agreed that they would probably pay pound 10 more than a sum that they had previously said they would most definitely not pay, if they found this to be the cost of the vaccine. Interview data supported the view that the payment scale had failed to elicit the maximum willingness to pay and that some participants used the information on cost to help clarify their values, in contrast to the theory underpinning willingness to pay. The results suggest a need to consider values-clarification in health economic evaluations.
使用支付意愿来评估医疗保健的效益正在增加。这项工作大多假定健康偏好是明确形成的或“完整的”，并且如果以正确的方式提出正确的问题，就能轻易地揭示出来。我们检验了这一假设，在一项混合方法研究中寻找证据，该研究探讨了对基于支付量表的支付意愿练习给出模糊回应的意义和影响。样本中有一半表示，他们的模糊性意味着他们的最大支付意愿实际上高于他们之前所说的数额。30%的人同意，如果发现疫苗的成本是这个数，他们可能会比之前明确表示绝对不会支付的数额再多付10英镑。访谈数据支持了这样一种观点，即支付量表未能引出最大支付意愿，而且一些参与者利用成本信息来帮助明确他们的价值观，这与支付意愿背后的理论相反。结果表明，在健康经济评估中需要考虑价值观的澄清。
