Martín-Fernández Jesús, López-Nicolás Ángel, Oliva-Moreno Juan, Medina-Palomino Héctor, Polentinos-Castro Elena, Ariza-Cardiel Gloria
Family and Community Medicine Teaching Unit Oeste, Primary Care Management, Madrid Health Service, Móstoles, Madrid, Spain.
Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Cost Eff Resour Alloc. 2021 May 5;19(1):27. doi: 10.1186/s12962-021-00281-9.
The preferences of citizens are a basic element to incorporate into the decision-making process when planning health policies. Contingent valuation (CV) is a common method for calculating the value for citizens that new technologies, interventions, and the provision of services or policies have. However, choosing the correct CV tool may not be a neutral decision. This work aims to assess the substitution of a healthcare service by comparing valuation differences between the willingness to pay (WTP) for the maintenance of the service versus the willingness to accept compensation (WTA) for its substitution, both of which are related to subject characteristics, with a particular focus on trust in institutions and risk aversion.
A CV study was designed to study Dutch population preferences when physician assistants replace anaesthesiologists. Differences between the distributions of WTA and WTP were compared through full decomposition methods, and conditional quantile regression was performed.
Nearly two-thirds of surveyed citizens expressed null values for WTA and WTP. The other third systematically reported a value of WTA higher than that of WTP, which increased further with lower income and the possible presence of a strategic bias. In contrast, being more than 65 years old, having trust in government, and preferring anaesthesiologists decreased the WTA-WTP difference. Risk aversion had no clear association with the WTA-WTP gap.
Known differences between the perceived value of health services from the perspective of gains and losses could be related to people's characteristics. Trust in government but not aversion to risk was related to the WTA-WTP differences. Identifying a profile of citizens who are averse to losing health services should be considered when designing and implementing health services or interventions or making disinvestment decisions.
公民的偏好是规划卫生政策时纳入决策过程的一个基本要素。条件估值法（CV）是一种计算新技术、干预措施以及服务或政策对公民价值的常用方法。然而，选择正确的CV工具可能并非一个中立的决定。这项研究旨在通过比较维持某项医疗服务的支付意愿（WTP）与接受该服务替代补偿的意愿（WTA）之间的估值差异，评估一项医疗服务的替代情况，这两者均与受试者特征相关，尤其侧重于对机构的信任和风险规避。
设计了一项CV研究，以研究当医师助理取代麻醉医师时荷兰人群的偏好。通过完全分解方法比较WTA和WTP分布之间的差异，并进行条件分位数回归。
近三分之二的受访公民表示WTA和WTP为零值。另外三分之一的人系统地报告WTA值高于WTP值，随着收入降低以及可能存在的策略性偏差，这一差异进一步增大。相比之下，年龄超过65岁、信任政府以及更倾向于麻醉医师会减小WTA - WTP差异。风险规避与WTA - WTP差距没有明显关联。
从收益和损失角度来看，健康服务感知价值之间的已知差异可能与人们的特征有关。对政府的信任而非风险规避与WTA - WTP差异有关。在设计和实施卫生服务或干预措施或做出撤资决策时，应考虑识别那些不愿失去卫生服务的公民特征。
