Abstract
BackgroundThe 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.MethodsA 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.ResultsNearly 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.ConclusionsKnown 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.
Highlights
The preferences of citizens are a basic element to incorporate into the decision-making process when planning health policies
Understanding the value placed on different healthcare services and discovering people’s preferences so as to shape health policy is Martín‐Fernández et al Cost Eff Resour Alloc (2021) 19:27 an essential task for good governance, which has been shown to improve healthcare efficiency and quality [2]
One of them is contingent valuation (CV), a method well-grounded in economics theory that assumes that personal preferences can be interpreted in the form of a utility function, where two states can be compared through the changes in the level of utility [3]
Summary
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. Understanding the value placed on different healthcare services and discovering people’s preferences so as to shape health policy is Martín‐Fernández et al Cost Eff Resour Alloc (2021) 19:27 an essential task for good governance, which has been shown to improve healthcare efficiency and quality [2]. Governments employ multiple strategies to face funding needs [5], one of which is disinvestment: “the processes of withdrawing health resources from existing healthcare practices that are deemed to deliver little or no health gain for their cost” [6]. A specific kind of substitution is that related to different skills, for example, substituting the performance of a task from one particular professional to another who is less specialized but can be more efficient [7]
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