Abstract
BackgroundInformal care, the health care provided by the patient’s social network is important in low income settings although its monetary value is rarely estimated. The lack of estimates of the value of informal care has led to its omission in economic evaluations but this can result in incorrect decisions about cost effectiveness of an intervention. We explore the use of contingent valuation methods of willingness to pay (WTP) and willingness to accept (WTA) to estimate the value of informal care provided to HIV infected women that are accessing antiretroviral therapy (ART) under the Option B+ approach to prevention of mother-to-child transmission (PMTCT) of HIV in Malawi.MethodsWe collected cross sectional data from 93 caregivers of women that received ART care from six health facilities in Malawi. Caregivers of women that reported for ART care on the survey day and consented to participate in the survey were included until the targeted sample size for the facility was reached. We estimated the value of informal care by using the willingness to accept (WTA) and willingness to pay (WTP) approaches. Medians were used to summarize the values and these were compared by the Wilcoxon signed-rank test.ResultsThe median WTA to provide informal care in a month was US$30 and the median WTP for informal care was US$13 and the two were statistically different (p < 0.000). Median WTP was higher in the urban areas than in the rural areas (US$21 vs. US$13, p < 0.001) and for caregivers from households from higher wealth quintile than in the lower quintile (US$15 vs. US$13, p < 0.0462).ConclusionInformal caregivers place substantial value on informal care giving. In low income settings where most caregivers are not formally employed, WTP and WTA approaches can be used to value informal care.Clinical trial numberNCT02005835. Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1381-y) contains supplementary material, which is available to authorized users.
Highlights
Informal care, the health care provided by the patient’s social network is important in low income settings its monetary value is rarely estimated
contingent valuation method (CVM) is a survey-based, hypothetical and indirect method of determining the monetary valuations associated with the provision of goods and services [19] by eliciting willingness to pay (WTP) or willingness to accept (WTA) a good or service by its users
The findings show that most of the informal caregivers were male and the majority of them were husbands of care recipients
Summary
The health care provided by the patient’s social network is important in low income settings its monetary value is rarely estimated. Revealed preference methods of opportunity cost and proxy good methods are the commonly used approaches to value informal care. Application of the revealed preference methods are challenging in low income countries because of the problems with measurement of time and its valuation. Valuation of informal care time by using wage rates is challenging in low income countries because a substantial proportion of caregivers are subsistence producers and don’t receive a market wage [6]. Opportunity cost method and the proxy good method may neglect the full impact of providing informal care on the caregiver. Providing informal care involves burden, morbidity risks and in some cases even mortality risks [3, 14, 15]
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