Department of Health Care Policy and Management, Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan; Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Japan.
Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Japan.
Soc Sci Med. 2014 Jun;110:31-40. doi: 10.1016/j.socscimed.2014.03.025. Epub 2014 Mar 26.
In the health sectors of low- and middle-income countries, contingent valuation method (CVM) studies on willingness to pay (WTP) have been used to gather information on demand variation or financial perspectives alongside price setting, such as the introduction of user fees and valuation of quality improvements. However, WTP found in most CVM studies have only explored the preferences that consumers express through their WTP without exploring whether they are actually able to pay for it. Therefore, this study examines the issues pertaining to WTP estimation for health services using the conventional CVM. We conducted 202 household interviews in 2008, in which we asked respondents about three types of public health services in Indonesia and assessed WTP estimated by the conventional CVM as well as in the scenario of "resorting to debt" to recognize their budget constraints. We find that all the demand curves for both WTP scenarios show gaps. Furthermore, the gap for midwife services is negatively affected by household income and is larger for the poor. These results prove that CVM studies on WTP do not always reveal WTP in the latter scenario. Those findings suggest that WTP elicited by the conventional CVM is different to that from the maximum price that prevents respondents from resorting to debt as their WTP. In order to bridge this gap in the body of knowledge on this topic, studies should improve the scenarios that CVM analyses use to explore WTP. Furthermore, because valuing or pricing health services based on the results of CVM studies on WTP alone can exacerbate the inequity of access to these services, information provided by such studies requires careful interpretation when used for this purpose, especially for the poor and vulnerable sections of society.
在中低收入国家的卫生部门，条件价值评估法（CVM）研究已经被用于收集需求变化或财务方面的信息，如引入用户付费和评估质量改进。然而，大多数 CVM 研究中的支付意愿（WTP）仅探索了消费者通过支付意愿表达的偏好，而没有探索他们是否有能力支付。因此，本研究使用传统 CVM 检验了与卫生服务支付意愿估计相关的问题。我们于 2008 年进行了 202 户家庭访谈，询问受访者有关印度尼西亚三种公共卫生服务的情况，并评估了传统 CVM 估计的支付意愿以及“诉诸债务”的情景下的支付意愿，以识别他们的预算约束。我们发现，两种支付意愿情景下的所有需求曲线都存在差距。此外，助产服务的差距受到家庭收入的负面影响，且对穷人更大。这些结果证明，CVM 研究中的支付意愿并不总是反映出后者情景下的支付意愿。这些发现表明，传统 CVM 中引出的支付意愿与防止受访者诉诸债务的最高价格所产生的支付意愿不同。为了弥合这一知识空白，研究应改进 CVM 分析中使用的情景，以探索支付意愿。此外，由于仅根据 CVM 研究中的支付意愿结果来评估或定价卫生服务可能会加剧获得这些服务的不公平性，因此在为此目的使用此类研究提供的信息时，需要谨慎解释，尤其是对于社会中贫困和弱势群体。
