Günther Oliver H, König Hans-Helmut
Department of Psychiatry, University of Leipzig, Germany.
Int J Technol Assess Health Care. 2006 Summer;22(3):351-61. doi: 10.1017/s0266462306051257.
Assessment of willingness to pay (WTP) by contingent valuation (CV) and choice experiments (CE) is increasingly performed in economic evaluation of health care. However, the question of whether the methods for measuring WTP are acceptable to decision makers and scientists has remained largely unacknowledged. The aim of this study was to learn more about decision makers' and scientists' opinion concerning these methods.
An expert group developed a questionnaire consisting of key items that may influence the opinion about CV and CE according to the constructs "attitude toward behavior," "subjective norm," and "behavioral intention" as defined by the Theory of Reasoned Action by Ajzen and Fishbein. In a survey, seventy-seven decision makers representing key institutions in the German healthcare system and forty-two scientists in health economics completed the questionnaire.
Scientists and decision makers in particular did not show a high intention to use methods for measuring WTP. Skepticism regarding precision of the methods and subjects' capability to imagine paying an amount of money for a certain health commodity were stated along with the assertion that the hypothetical decision-making scenario was rather a distant reality. Nevertheless, the majority of scientists and decision makers did not state rejection of the methods.
Increasing the probability of using methods for measuring WTP in health care, the hypothetical scenarios should be made more realistic and payment vehicles should be used to help patients relate payment to a real health benefit. Moreover, an intensive discussion on the potential usefulness of CV/CE without excluding ethical concerns in comparison to existing alternatives has to be resumed.
在医疗保健的经济评估中，越来越多地采用条件价值评估法（CV）和选择实验法（CE）来评估支付意愿（WTP）。然而，衡量WTP的方法是否为决策者和科学家所接受，这一问题在很大程度上仍未得到关注。本研究的目的是更深入地了解决策者和科学家对这些方法的看法。
一个专家小组根据阿杰恩和菲什拜因的理性行动理论所定义的“对行为的态度”“主观规范”和“行为意图”等结构，编制了一份包含可能影响对CV和CE看法的关键项目的问卷。在一项调查中，代表德国医疗保健系统关键机构的77名决策者和42名卫生经济学领域的科学家完成了该问卷。
科学家和决策者尤其没有表现出很高的使用衡量WTP方法的意愿。他们表示对这些方法的准确性以及受试者想象为某种健康商品支付一定金额的能力持怀疑态度，同时认为假设的决策情景与现实相差甚远。尽管如此，大多数科学家和决策者并未表示拒绝这些方法。
为了提高在医疗保健中使用衡量WTP方法的可能性，应使假设情景更具现实性，并应使用支付工具来帮助患者将支付与实际的健康益处联系起来。此外，必须重新展开关于CV/CE与现有替代方法相比的潜在有用性的深入讨论，且不排除伦理问题。
