Willingness to pay for physician services in Ukraine and other central and eastern European countries : application of stated preferences techniques to the assessment of patient charges: Thesis

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Date
2014-06-25
Authors
Danyliv, Andriy
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Abstract
Willingness to pay derived using stated preference techniques (i.e. valuation methods, assessing willingness to pay for certain benefits in hypothetical purchase or choice scenarios) is increasingly used for the valuation of health care benefits. The use of stated preference techniques is conditioned by their ability to provide monetary values for previously unknown or non-traded benefits for which no proxy markets are known. Another advantage is that stated preference techniques capture passive use values, i.e. utility obtained from the mere availability of a benefit without usage, which is especially relevant in health care. Nonetheless, stated preference techniques have gained very limited space in the assessment of patient charges and their design. This might be due to uncertainty whether stated willingness to pay actually reflects the willingness to pay in real world decisions. This uncertainty is known as hypothetical bias. Moreover, the two main stated preference techniques, discrete choice experiments and contingent valuation, do not demonstrate convergence in their valuation measures. Despite the abovementioned problems, stated preference techniques, if appropriately designed, are recognized as a valid tool for the valuation of environmental benefits. By the same token, in many health care systems, where health benefits have never been traded, stated preference techniques are the only way of assessing patients’ willingness to pay. This is the case in many post-socialist Central and Eastern European countries where formal patient charges for health care services are not common. Patient charges for physician services are advised as an efficient policy tool for the reduction of unnecessary use of services, superseding informal charges (which are widespread in Central and Eastern European countries) and to some extent as an additional source of health care funding. In Central and Eastern Europe, however, in the post-socialistic context, many countries are reluctant to undertake such unpopular measures as the introduction of formal charges for physician visits. This ignorance, however, lacks evidence from the assessment of patient charges and their effects. Most of the evidence is based on revealed preference data (i.e. data or past service utilization) and, hence, comes from Western Europe, USA, and some Asian countries, where patient charges are already effectively implemented. For Central and Eastern European countries such evidence is lacking.
В дисертації показано як готовність сплачувати, оцінена за допомогою висловлених уподобань, може бути використана для оцінювання платежів пацієнтів та аспектів їхнього дизайну: прийнятності таких платежів, визначенні рівня платежів, неоднорідності готовності сплачувати серед груп населення, визначення інвестиційних пріоритетів в якість та доступ. Платежі пацієнтів за послуги охорони здоров’я, хоча їх і уникають в країнах Центральної та Східної Європи, можуть стати ефективним інструментом політики в тому сенсі, що люди готові офіційно сплачувати суттєві кошти за послуги адекватної якості та доступу. Забезпечення такої якості і доступу, а також викорінення неофіційних платежів, буде необхідним кроком у встановлені оптимальної політики платежів пацієнтів.
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