Willingness to pay for physician services at a primary contact in Ukraine: results of a contingent valuation study
Loading...
Date
2013
Authors
Danyliv, Andriy
Pavlova, Milena
Gryga, Irena
Groot, Wim
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: The existence of quasi-formal and informal payments in the Ukrainian health care system jeopardizes
equity and creates barriers to access to proper care. Patient payment policies that better match patient preferences
are necessary. We analyze the potential and feasibility of official patient charges for public health care services in
Ukraine by studying the patterns of fee acceptability, ability and willingness to pay (WTP) for public health care
among population groups.
Methods: We use contingent valuation data collected from 303 respondents representative of the adult Ukrainian
population. Three decision points were separated: objection to pay, inability to pay, and level of positive non-zero
WTP. These decisions were studied for relations with quality profiles of the services, and socio-demographic
characteristics of the respondents and their households.
Results: The likelihood to object to pay is mostly determined by the quality characteristics of the services.
Objection to pay is not related to corresponding behavior in real life. The likelihood of being unable to pay is
associated with older age, lower income, and a larger share of household members with no income. The level of
positive WTP is positively related to income (+7% per 1000 UAH increase in income) and is lower for people who
visited a doctor but did not pay (−22%).
Conclusions: Rather substantial WTP levels (between 0.9% and 1.9% of household income) for one visit to
physician indicate a potential for official patient charges in Ukraine. User fees may cover a substantial share of
personnel cost in the out-patient sector. The patterns of inability to pay support well designed exemption criteria
based on age, income, and other aspects of economic status. The WTP patterns highlight the necessity for
payments that are proportional to income. Other methodological and policy implications are discussed.
Description
Keywords
Willingness to pay, Demand, Contingent valuation, Physician services, Ability to pay, Payment acceptance