Department of Health Sciences, VU University Amsterdam, The Netherlands.
Health Policy. 2011 Aug;101(3):300-11. doi: 10.1016/j.healthpol.2010.10.001. Epub 2010 Dec 18.
This study analyzes peoples' social preferences for individual responsibility to health-risk behaviour in health care using the contingent valuation method adopting a societal perspective. We measure peoples' willingness to pay for inclusion of a treatment in basic health insurance of a hypothetical lifestyle dependent (smoking) and lifestyle independent (chronic) health problem. Our hypothesis is that peoples' willingness to pay for the independent and the dependent health problems are similar. As a methodological challenge, this study also analyzes the extent to which people consider their personal situation when answering contingent valuation questions adopting a societal perspective. 513 Dutch inhabitants responded to the questionnaire. They were asked to state their maximum willingness to pay for inclusion of treatments in basic health insurance package for two health problems. We asked them to assume that one hypothetical health problem was totally independent of behaviour (for simplicity called chronic disease). Alternatively, we asked them to assume that the other hypothetical health problem was totally caused by health-risk behaviour (for simplicity called smoking disease). We applied the payment card method to guide respondents to answer the contingent valuation method questions. Mean willingness to pay was 42.39 Euros (CI=37.24-47.55) for inclusion of treatment for health problem that was unrelated to behaviour, with '5-10' and '10-20 Euros' as most frequently stated answers. In contrast, mean willingness to pay for inclusion treatment for health-risk related problem was 11.29 Euros (CI=8.83-14.55), with '0' and '0-5 Euros' as most frequently provided answers. Difference in mean willingness to pay was substantial (over 30 Euros) and statistically significant (p-value=0.000). Smokers were statistically significantly more (p-value<0.01) willing to pay for the health-risk related (smoking) problem compared with non-smokers, while people with chronic condition were not willing to pay more for the health-risk unrelated (chronic) problem than people without chronic condition. This suggests that sub groups of people might differ in terms of abstracting from their personal situation when answering valuation questions from a societal perspective.
本研究采用条件价值评估法，从社会角度分析人们对医疗保健中个人对健康风险行为责任的社会偏好。我们衡量人们对纳入基本健康保险的治疗方案的支付意愿，针对的是一个依赖生活方式的假设性健康问题（吸烟）和一个独立于生活方式的假设性健康问题（慢性疾病）。我们的假设是，人们对独立和依赖健康问题的支付意愿是相似的。作为一个方法学上的挑战，本研究还分析了人们在从社会角度回答条件价值评估问题时，在多大程度上考虑了自己的个人情况。513 名荷兰居民对问卷做出了回应。他们被要求为两种健康问题的治疗方案纳入基本健康保险计划的支付意愿。我们要求他们假设一个假设的健康问题完全独立于行为（为简单起见，称为慢性疾病）。或者，我们要求他们假设另一个假设的健康问题完全由健康风险行为引起（为简单起见，称为吸烟疾病）。我们采用支付卡方法指导受访者回答条件价值评估方法问题。对于与行为无关的健康问题，平均支付意愿为 42.39 欧元（置信区间为 37.24-47.55），“5-10 欧元”和“10-20 欧元”是最常给出的答案。相比之下，对于与健康风险相关的问题的治疗方案的平均支付意愿为 11.29 欧元（置信区间为 8.83-14.55），最常提供的答案是“0 欧元”和“0-5 欧元”。平均支付意愿的差异很大（超过 30 欧元），且具有统计学意义（p 值=0.000）。与不吸烟者相比，吸烟者在统计学上更愿意为与健康风险相关的（吸烟）问题支付更多费用（p 值<0.01），而患有慢性疾病的人并不愿意为与健康风险无关的（慢性）问题支付更多费用，而不患有慢性疾病的人则不愿意支付更多费用。这表明，在从社会角度回答评估问题时，人们可能会根据自己的个人情况进行抽象化，不同亚组的人可能存在差异。
