Monetary valuation of COVID-19 informal care: caregivers' willingness to pay and willingness to accept

BACKGROUND

Informal care can reduce hospitalization frequency and time, elevate bed turnover, and increase the health systems' capacity. This type of care has shown meaningful value in managing many cases through the COVID-19 pandemic. The present study aimed to identify determinants of monetary valuation of informal care and the burden of this care on the COVID-19 patients' caregivers.

METHODS

Through a cross-sectional phone survey from June to September 2021 in Sanandaj city, the west of Iran, COVID-19 patients and their caregivers (Each Group No. 425) were separately interviewed. A simple probabilistic sampling method was applied. Two questionnaires were developed and used after validation. Monetary valuation of informal caregivers was done using Willingness to pay (WTP) and willingness to accept (WTA). Double hurdle regressions were used to determine related variables to WTP/WTA. R software was used for the data analysis.

RESULTS

The total mean (Standard Deviation) of WTP and WTA were $12.02(28.73), $10.30(15.43) USD. Most respondents put a zero value on informal care by WTA (243(57.18%) and WTP [263 (61.88%)]. Caregivers' Employment, and being spouse/child of the care recipient increased the probability of reporting a positive value for WTP (p-value < 0.0001, p-value = 0.011 respectively) and WTA (p-value = 0.004, p-value < 0.0001 respectively). An increase in the number of caring days decreased the probability of reporting positive WTA (p-value = 0.001) and increased the mean of lnWTP (p-value = 0.044). Perceived difficulty in doing indoor activities and perceived difficulty in doing outdoor activities decreased lnWTA mean (p-value = 0.002) and lnWTP mean (p-value = 0.043) respectively.

CONCLUSIONS

Increasing caregivers' self-efficacy and facilitating their involvement in the caring process could be facilitated through flexible work status, educational programs, and interventions on decreasing their burnout.

Caregivers' willingness to pay for digital support services: Comparative survey

BACKGROUND

Considering the substantial information needs experienced by informal caregivers, the increased availability of digital support services for caregivers as well as the potential they offer, further understanding of caregivers' willingness to pay for digital support services is needed.

OBJECTIVE

The aim of this study is to identify associations between informal caregiver's characteristics and their willingness to pay for digital support services in two countries: Italy and Sweden.

METHODS

A sample of 378 respondents participated in a cross-sectional survey. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre. A two-part regression model was used. In the first part, logistic regression analysis was applied to investigate the association between willingness to pay and sets of independent variables (caregiver's demographics, caregiver's socioeconomic resources and caregiving context). In the second part, a generalized linear model (log-link and gamma distribution) was applied to determine the adjusted mean willingness to pay.

RESULTS

More than half of the participants from both countries of our study were willing to pay out of pocket for digital support services. A recommendation by a healthcare professional was the top factor that may motivate caregivers' willingness to pay an additional amount for a paid version of a digital support service. In both countries, the majority of the respondents believe that the government should allocate more funds for digital support services and for improving digital infrastructures. Caregiver' s gender, care recipient relationship to the caregiver, care duration, the total household income and the amount spent per month on professional caregiving services are all associated with willingness to pay. For every additional 10 Euro increase in the amount spent per month on professional caregiving services, the odds of willingness to pay an additional Euro for a digital support service increased by 0.60 % in the Italian sample (p= 0.002, 95% CI: 1.002, 1.009) and 0.31% in the Swedish sample (p=0.015, 95% CI: 1.006, 1.057).

CONCLUSIONS

Factors such as demographics, socioeconomic resources and the caregiving context may play a role in caregivers' willingness to pay for digital support services. The digital and social divide may negatively affect caregivers' willingness to pay for digital support services. Policy makers and insurance providers should consider innovative policies to fund digital support services that have been shown to be effective at supporting and improving caregivers' health outcomes via subsidies or other incentives. Future research that evaluates the cost-effectiveness of digital support services is needed in a context of a growing number of informal caregivers and ever scarcer resources.

The monetary facilities payment for ecosystem services as an approach to restore the Degraded Urmia Lake in Iran

This study analyzed the potential use of Payment for Ecosystem Services (PES) as a strategy for improving water supply management. This study focused on the Siminehroud Sub-basin due to its high importance to the Basin of Urmia Lake (UL). Siminehroud is the second provider of water (by volume) to Urmia Lake. To evaluate the technical and economic feasibility of a PES scheme, the current land use map was extracted using satellite imagery. In addition, the two algorithms of Support Vector Machines (SVMs) and Maximum Likelihood (ML) are used for Landsat images classification, rather than analyzing the relationship between land use and ecosystem services. Then, the most relevant ecosystem services provided in the region were evaluated using the Benefit Transfer Method. In the last step, by designing and implementing a survey, on the one hand, the local farmers' Willingness to Accept (WTA) cash payments for reducing the area they cultivate, and on the other hand, the farmers' Willingness to Pay (WTP) for managing the water consumption were determined. The results illustrated that the WTA program is more acceptable among the beneficiaries. It is also notable that this program needs very high governmental funding. Furthermore, the results of the program indicate that the land area out of the cultivation cycle will gradually increase while the price of agricultural water will also increase.

Influence of poverty concerns on demand for healthier processed foods: A field experiment in Mexico City

Living in poverty can present cognitive biases that exacerbate constraints to achieving healthier diets. Better diets could imply food choice upgrades within certain food categories, such as electing processed foods with an improved nutritional profile. This study evaluated the influence of monetary and health concerns on the willingness to pay (WTP) for healthier processed foods in a low-income section of Mexico City. We employed priming techniques from the scarcity literature, which are applied for the first time to healthier food purchasing behaviours in low-income settings. Our predictions are based on a dual system framework, with choices resulting from the interaction of deliberative and affective aspects. The WTP was elicited through a BDM mechanism with 423 participants. Results showed that induced poverty concerns reduced the valuations of one of the study's healthier food varieties by 0.17 standard deviations. The latter effect did not differ by income level. The WTP for a healthier bread product but one with relatively high sugar and fat content was reduced by induced poverty concerns only among certain consumers without bread purchasing restrictions (78% of the sample). Potential mechanisms were assessed through regression analysis and structural equation modelling. The relationship between poverty concerns and WTP was mediated by increased levels of stress. While we could not rule out impact on cognitive load, it was not deemed a mediator in this study. Our findings signal that improvements in economic and psychological well-being among low-income consumers may aid to increase their demand for healthier processed foods.

Sociopolitical values, sociodemographic factors, and willingness to pay higher taxes to improve public healthcare in Turkey

OBJECTIVES

Healthcare systems' reliance on taxes varies across countries with corresponding heterogeneity in public's willingness to pay taxes (WTP) for national healthcare provision. Turkey, a developing country that witnessed a major healthcare transformation, provides a unique context to understand what motivates WTP in a non-Western context.

STUDY DESIGN

This is a cross-sectional study.

METHODS

We used the data from the International Social Survey Programme module on health and healthcare in Turkey. The data were collected from a nationally representative sample of adults aged >18 years (n = 1559). Using logistic regression models, we examine the association of sociopolitical values and sociodemographic factors with individuals' WTP to improve public healthcare.

RESULTS

We find that sociopolitical values are more closely associated to the WTP in Turkey compared with sociodemographic factors. However, egalitarianism and humanitarianism were differentially linked to the WTP. Humanitarianism was positively associated, whereas egalitarianism was negatively associated with WTP.

CONCLUSIONS

This study shows the prevalence of value-based approach to healthcare provision support in a developing country in the height of healthcare reforms.

Consumers' willingness to pay for health claims during the COVID-19 pandemic: A moderated mediation analysis

The COVID-19 pandemic has posed a substantial threat to people's lives and raised health concerns. This research explores the mediating role of consumers' attitudes towards health claims in the relationship between consumers' interest in health claims and their willingness to pay (WTP) for health claims in extra virgin olive oil (EVOO). Additionally, we examine the moderation effect of COVID-19 risk perception in the relationship between consumers' interest in and attitudes towards health claims. Data were collected through an online survey in three countries: Spain, the UK and Chile. Findings confirm the mediating role of consumers' attitudes towards health claims. Furthermore, the relationship between consumers' interest and their attitudes towards health claims was stronger when COVID-19 risk perception was higher.

Is there a stronger willingness to pay for air quality improvement with high education: new evidence from a survey in China

As a developing country with the largest population and serious environmental pollution in the world, China has made great efforts in air pollution. Air quality improvement depends not only on government administrative regulations but also on public support, especially how much the public is willing to pay for air quality improvement. Higher education will encourage the public to take action to improve air quality. However, the confirmation of the causality relationship between WTP and education has been missing. This study uses the Chinese General Social Survey (CGSS) to find the relationship between the two, and the conclusions are drawn: OLS regression model and instrumental variable both determine the positive influence of education level on air quality improvement WTP, and Heckman model further verifies the robustness of the conclusion. The positive influence of education level is greater in the groups of men, higher income, higher awareness of acid rain, and more air purifiers, and it has a greater impact on married people in rural areas than in urban areas. The function mechanism of education can improve residents' WTP by increasing regional GDP, promoting urbanization level, expanding afforestation areas, decreasing private car ownership and the number of newly registered civil cars, and reducing sulfur dioxide emissions, nitrogen oxides, and smoke (powder) dust. The total social and economic value of air quality improvement in China is 34.572 billion CNY to 672.42 trillion CNY.

Valuation of student-led agricultural activities at university: comparison of willingness to pay with inferred values

Agricultural fields in university campuses can improve urban nutrition security, increase greenery, and provide opportunities for students to grow crops and enhance self-management skills. We conducted student surveys among freshmen in two different years (2016 and 2020) to understand their willingness to pay (WTP) for donations toward student-led agricultural activities. In order to mitigate the social desirability bias, we also asked students' inferred WTP and compared that with conventional WTP. We found that inferred values could determine more conservative and realistic estimations of students' donations than conventional WTP. Full model regression analysis using logit model estimation showed that students' interest and engagement in pro-environmental behaviors increased WTP for student-led agricultural activities. In conclusion, such projects are economically feasible through student donations.

Differences and determinants for polluted area, urban and rural residents' willingness to hand over and pay for waste mobile phone recycling: Evidence from China

Currently, China has the largest generation volume of waste mobile phones (WMPs), but the recycling rate is still negligible. How to improve the willingness to hand (WTH) over to formal recycling channels and willingness to pay (WTP) have become the most core problems in the e-waste recycling industry. As the important link between WMPs generation and collection, the residents' role and function are attracting more and more attention. Thus, this study is designed to identify the determinants of the residents' WTH and WTP for WMPs through the contingent valuation method (CVM). At the same time, it will explore the current existing gaps from the urban and rural residents. Especially, this study also considers Guiyu Town as one special rural region for understanding the differences with other regions. The results show that the respondents generally have the relatively lower knowledge and cognition on WMPs recycling. Only 9.4% respondents are satisfied with the current government's management of WMPs. Personal information leakage is an important reason for low WTH. The WTH of Guiyu, urban and rural respondents were 51.3%, 45.9% and 41.2%, respectively; while their WTP were 46.80%, 31.70% and 37.80%, respectively. Finally, it is estimated that their WTP values were 18.75 ($2.81), 16.14 ($2.42) and 15.85 ($2.38) RMB per unit, respectively. The demographic variables, cognition and attitude are important factors on all residents' WTH and WTP. Meanwhile, it is indicated that if owning higher WTH, the residents will trend to higher WTP. Especially, the WTH and WTP of Guiyu residents are higher than other residents.

Addressing key issues in HIV self-test program implementation for Black and Latino sexual minority men in the Southern United States: a multiphase study protocol

BACKGROUND

Black and Latino sexual minority men in the Southern United States have the highest HIV infection rates in the country. Increased HIV testing can help decrease onward HIV transmission through detecting previously undiagnosed infections. HIV self-testing is an evidence-based strategy to increase HIV testing among sexual minority men, but the implementation of this intervention in the Southern United States is limited. One implementation barrier is the lack of knowledge of Black and Latino sexual minority men's preferences for various HIV self-testing program characteristics and their willingness to pay for these preferences. In addition, little is known about facilitators and barriers to initiating HIV self-testing programs from the perspectives of HIV prevention implementation decision-makers in this region.

METHODS

We will conduct an online discrete choice experiment among Black and Latino sexual minority men in the Southern United States (n = 300) to estimate this population's preferences for the following HIV self-testing program characteristics: delivery strategy (home delivery, peer delivery, clinic pickup); delivery speed (same day, next day, 3 days, and 5 days); support (instructions only, during test, and 1 week after delivery); and price ($0, $20, $40, $50, $60). We will also use this choice data to generate willingness-to-pay estimates for each program characteristic. Guided by the Consolidated Framework for Implementation Research, we will then conduct semi-structured interviews (n = 30) with HIV prevention program decision-makers at various health organizations serving Black and Latino sexual minority men in the region to further understand facilitators and barriers to implementation of the most preferred HIV self-testing program design.

DISCUSSION

By gaining perspectives on HIV self-testing implementation from patients and providers, this project will build a roadmap for the initiation of HIV self-testing programs to decrease HIV incidence among one of the most disproportionately impacted populations in the USA.

Attitudes and willingness to pay for clean heating by typical households: a case study of rural areas in Yongcheng City, Henan Province, China

Understanding households' attitudes and willingness to pay (WTP) for clean heating can provide a scientific basis for decision-makers to assess the potential to develop clean heating, choose heating methods, and formulate subsidy standards in the region. In this paper, the double-bounded dichotomous contingent valuation method-modified by the spike model-was used to better estimate the actual WTP of households through a sample survey of 456 households in rural areas of Yongcheng City, China, in 2021. The factors influencing attitudes and WTP were examined to reveal mechanisms of accepting clean heating. The results showed that 94.96% of households were willing to pay for clean heating. The annual WTP was 1071 yuan per household, more than eight times the current heating cost. Factors that affect clean heating attitudes do not necessarily affect the WTP. Specifically, gender, length of time spent living at home, and family income had significant influences on WTP, whereas the educational level, adaptive perceptions in relation to environmental perceptions, and the recognition variables for gender equality in energy consumption had a significant impact on attitudes. It is worth noting that elderly people and females were identified as vulnerable groups in the implementation of clean heating.

Assessing the preference and spatial dependence of a solid waste management system in Nepal: A choice experiment approach

This study deploys a choice experiment method to estimate the preference and willingness to pay for a better solid waste management system in Siddharthanagar municipality in Nepal. A primary survey of 611 households was conducted, and the results from the Generalized Multinomial Logit Model (GMNL) indicate a public preference for a better waste management service. Significant heterogeneity in household preferences is evident after accommodating each choice selection's preference certainty in the GMNL model. On average, households prefer to pay the highest amount for constructing and maintaining a sanitary landfill, which is Nepalese Rupee (NPR) 158/month (USD 1.43). The geographic distribution of the marginal willingness to pay (MWTP) by hot spot analysis from the geocoded location also indicates spatial heterogeneity across the study area. The MWTP for each waste management attribute is spatially autocorrelated, and household awareness and attitude significantly impact this spatial dependence. Overall, both the choice models result and spatial analyses indicate the policy should be targeted at a localized level to increase awareness concerning the proper management of solid waste.

Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania

Background

Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania.

Methods

Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children.

Findings

All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8 %) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95 % confidence interval Tsh 2,523-3,610; 1 USD ∼ Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children.

Interpretation

Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness.

ClinicalTrialsgov Protocol

NCT03252288.

Combining revealed and stated preference models for artificial reef siting: A study in the Florida Keys

This paper investigates divers' preferences for artificial reef diving and willingness to pay (WTP) for large ship, artificial reef site attributes in the Florida Keys. We investigate diver demand for existing decommissioned ships that have been sunk off the Florida Keys as well as demand for four new vessels that are available for disposal from the U.S. Department of Transportation Maritime Administration inventory. Using survey data from divers, we compare revealed preference (RP) site choices, stated preference (SP) choices from a discrete choice experiment, and joint RP/SP choices. Our analysis also incorporates stated attribute non-attendance (ANA) at the choice-task level. Our results indicate that the joint RP/SP models with stated ANA are preferred, leading to decreases in marginal WTP as well as decreases in the variability of marginal WTP estimates in the 95% confidence intervals. Results provide a framework for directing more efficient future decision making regarding sinkings at locations that will enhance welfare for divers.

Willingness to pay for COVID-19 mitigation measures in public transport and paratransit in low-income countries

In order to combat the spread of COVID-19, various measures were taken in most countries to make public transit and paratransit safer. These additional measures, which include restrictions on number of passengers, provision of hand sanitisers and face coverings, and more frequent cleaning, add to the costs of operations or reduce profitability. The resulting financial pressure on the transport operators raises an important question on who pays for these additional measures. In most countries, this has been covered by one-time government bailouts to operators or strategies to increase fare, the latter of which directly affects the users. However, even without these interventions, there could be a demand and as such willingness to pay (WTP) for some of these intervention measures from the consumers concerned about safety. Knowing such WTP will not only help operators set their fare, but also help the governments decide the appropriate bailout needed. This paper addresses the issue by estimating the user's willingness to pay for selected COVID-19 mitigation measures in public transport and paratransit (motorcycle taxis) using survey data collected from two cities in low-income countries as case studies - Kampala, Uganda and Dhaka, Bangladesh. For public transport, these measures are - (1) social distancing (passenger loading at half capacity), and (2) mandatory hand sanitisation and increased cleaning of surfaces, while for paratransit, they are - (1) provision of a transparent shield between the rider and the passenger, and (2) provision of cleaned helmets at the start of each trip. The study analyses stated preference data using the utility maximisation framework and finds that the implementation or provision of COVID-19 mitigation measures improves the attractiveness of the associated public transport or paratransit alternatives, and transport users make trade-offs between safety and cost when making travel decisions. We find positive willingness to pay for all four mitigation measures, suggesting potential existence of a market for these measures. We also find that the typical mode choice factors such as costs, travel time and convenience became less important during the pandemic and the safety measures became more important considerations.

A dataset on the sensory and affective perception of Bordeaux and Rioja red wines collected from French and Spanish consumers at home and international wine students in the lab

This article describes a dataset providing temporal sensory descriptions and affective answers for red wines: two Bordeaux and two Riojas. The wines were tasted at home by French (FR, n=106) and Spanish (SP, n=98) consumers and in the lab by wine students (WC, n=47). Standardized information was displayed on the samples (country and region of origin, name, producer, vintage, alcohol content). The FR and SP panels were split into three groups, the first having no rating information, the second having expert rating information (based on Wine Advocate ratings), and the third having consumer rating information (based on online Vivino reviews). The participants first rated their expected liking for the four wines. Then, for each wine sample, they had (in order) to taste the sample while being video recorded, rate their liking, temporally describe the sequence of sensations they perceived using Free-Comment Attack-Evolution-Finish, answer several questions about familiarity and quality perception, and declare their willingness to pay (reserve price). Then, they had to rank the four wines according to their quality. General questions about wine involvement, subjective wine knowledge, valuation behaviour, purchasing, and consumption patterns were asked. Finally, an auction was resolved: participants declaring a reserve price greater than the drawn price won a bottle. The data were used to assess the influence of culture and expertise on temporal sensory evaluations in an article entitled "Using Free-Comment to investigate expertise and cultural differences in wine sensory description". The data can be reused by researchers interested in studying the impact of external information on preferences and choices or investigating the sensory drivers of liking.

On the use of contingent valuation method to assess factors affecting the contribution of local people for the management of water hyacinth in Lake Tana, northwestern Ethiopia

The colonization of freshwater lakes by invasive alien species is increasingly alarming primarily owing to nutrient loads from the watersheds. For the sustainable management of invasive weeds, preventive methods, such as watershed management and sustainable agricultural practices, are recommended. Watershed protection activities by the upstream local community are believed to be effective measures to reduce nutrient loading to the receiving water bodies and hence help prevent the spread of water hyacinth. However, their willingness and potential contributions determine the effectiveness of watershed management activities. The objective of this study is, therefore, to evaluate the preferences and contributions (willingness to pay and willingness to contribute labor) of the local community for the management of water hyacinth in Lake Tana (Ethiopia). A contingent valuation method for a hypothetical market "prevention of water hyacinth infestation of Lake Tana through watershed management program" was used to collect data from 560 randomly selected households. A multivariable interval regression model was used to identify factors affecting the contribution of local people. The mean yearly willingness to pay and to contribute labor of the respondents was 435.4 Ethiopian Birr (US$ 10) and 22.4 man-days, respectively. The place of residence (rural/urban), educational level, private farm plot area, annual income, and water hyacinth-related conference participation significantly influenced the willingness to pay. Similarly, the willingness to contribute labor was strongly associated with place of residence, location, educational level, and household family size. The economic value derived from this study reflects community preferences, which could be an input for informed and evidence-based decision-making regarding the prevention of weed expansion and sustainable use of ecosystem services. Therefore, local, regional, and national authorities are advised to mobilize the local community to contribute labor and/or money so as to halt the expansion of the weed.

Determinants of willingness to pay for health services: a systematic review of contingent valuation studies

INTRODUCTION

Stated preference studies are a valuable tool to elicit respondents' willingness to pay (WTP) for goods or services, especially in situations where no market valuation exists. Contingent valuation (CV) is a widely used approach among stated-preference techniques for eliciting WTP if prices do not exist or do not reflect actual costs, for example, when services are covered by insurance. This review aimed to provide an overview of relevant factors determining WTP for health services to support variable selection.

METHODS

A comprehensive systematic literature search and review of CV studies assessing determinants of WTP for health services was conducted, including 11 electronic databases. Two of the authors made independent decisions on the eligibility of studies. We extracted all determinants used and related p values for the effect sizes (e.g. reported in regression models with WTP for a health service as outcome variable). Determinants were summarised in systematic evidence tables and structured by thematic domains.

RESULTS

We identified 2082 publications, of which 202 full texts were checked for eligibility. We included 62 publications on 61 studies in the review. Across all studies, we identified 22 WTP determinants and other factors from 5 thematic domains: sociodemographic characteristics, perceived threat, perceived benefit, perceived barriers, and other information.

CONCLUSION

Our review provides evidence on 22 relevant determinants of WTP for health services, which may be used for variable selection and as guidance for planning CV surveys. Endogeneity should be carefully considered before interpreting these determinants as causal factors and potential intervention targets.

Public willingness to pay for eradicating a harmful marine organism: the case of Aurelia aurita in South Korea

Aurelia aurita (AA), a legally registered harmful marine organism in South Korea, is damaging marine human leisure activities, local residents' tourism income, fisheries, and cooling water intake at power plants. The government is therefore seeking to eradicate AA by removing AA-attached larvae (polyps). This article looks into the public willingness to pay (WTP) for the eradication, utilizing a contingent valuation. For the sake of eliciting the WTP response, the one-and-one-half-bounded (OB) model was adopted. For comparison, the single-bounded (SB) model, which uses only the response to the first question in the OB model, was also applied. A spike model with a considerable plausibility that could explicitly deal with zero WTP responses was employed. Consequently, the estimation results of the SB model were used for further policy analysis. The household average WTP was estimated as KRW 3,911 (USD 3.49) per year, securing statistical significance. The national value was KRW 80.46 billion (USD 71.71 million) per annum. This figure can be interpreted as public value of the AA eradication project and used as essential basic data to evaluate the economic feasibility of implementing the project. Some factors such as income and education level significantly positively affected the intention of paying a suggested bid.

Estimating willingness to pay for diabetes complications

BACKGROUND

Maximum willingness to pay (WTP) for a health benefit is connected to perceived value. This two-center study aims to analyse diabetic patients' WTP for obtaining a specific preventive treatment package to reduce severe diabetic complications and determine the factors that impact this value.

METHODS

This cross-sectional research included 557 diabetics from two cities in Iran. The WTP for a preventative package minimising major diabetes complications (cardiovascular, renal, ocular, and diabetic foot) by 50% and 100% was tested using eight scenarios. The Diabetes Attitude Scoring Questionnaire (DAS-3) was used to examine patient attitudes toward diabetes. To determine WTP, a two-stage hurdle method was used. The level of significance was fixed to 0.05.

RESULTS

Around 80% of 557 people interviewed (mean age 47.54) stated they wanted to pay for a diabetes prevention package. This package's WTP varied from 169.4 to $374.5 depending on the complication and degree of risk reduction. The largest value diabetic patients willing to pay for preventative packages that reduce the chance of blindness was reported, while the lowest cost was stated for the diabetic foot. WTP is influenced by wealth, location of study, marital status, and attitude toward special training, but not by the type of diabetes, inpatient or outpatient setting, or the complications diabetes patients are impacted by. Patients' diabetes attitudes were mainly negative. The score of the attitude of patients towards diabetes was generally suboptimal.

CONCLUSION

Most diabetic patients were willing to pay for a preventive package and this value was not affected by the type of diabetes and its severity. Our research found that diabetic individuals are willing to pay the most for a preventative package that reduces the chance of blindness, and the least for diabetic foot care. WTP can help health officials allocate resources and manage budgets. The attitude of diabetic patients toward diabetes still needs further interventional research, however.

Willingness to pay for cleaning up beach litter: A meta-analysis

At the global level, the UN 2030 Agenda for Sustainable Development Goal 14 calls for action to significantly reduce marine litter pollution by 2025. To understand the non-market benefits of removing marine litter, researchers have conducted numerous studies on Willingness to Pay (WTP) for reductions in beach litter. This paper estimates the overall effect size of WTP for a worldwide dataset of 63 primary studies over 22 years by applying a meta-regression technique to assess the variability in WTP estimates. The results show an annual mean effect size of $US0.71 (or $US35.29) per person for a 1 % (for a corresponding 50 %) reduction in all types of beach litter. The observed heterogeneity is associated with WTP elicitation methods, beach attributes, geographic locations, and per-capita income. This study yields valuable information for policy makers to develop cost-effective policies and recommends standardised measurements to benchmark changes in marine litter pollution.

Quantifying the spatial preferences heterogeneity to upgrade the endemic ecological attributes for a cleaner environment: Evaluating the feasibility of benefit transfer among sub-basins of an inland river

The role of wetlands in the conservation of global biodiversity is very significant due to the provision of various benefits to households. The assessment of these benefits and general public perception in terms of their willingness to pay for restoring the degraded ecosystem services is also heterogeneous because of their spatial preferences. This research employed a choice experiment technique to evaluate willingness to pay of the households to improve the current degraded ecosystem services and assessed benefit transfer among upper, middle and lower sub-basins of Heihe River. The outcomes of the study were estimated through two models, i.e. the conditional logit and random parameter logit models. The heterogeneous willingness to pay amounts for ecosystem services confirm the variations in taste and preferences of the respondents across all sub-basins. Considering spatial heterogeneity of the preferences, the random parameter logit model resulted in smaller transfer errors than the conditional logit model. The values of transfer errors estimated by the random parameter logit model from the lower to the upper sub-basin, from the upper to the middle sub-basin and from the middle to the lower sub-basin were 17.76%, 80.65% and 33.92%, respectively, and the reason for these smaller values is the consideration of taste and preferences of the respondents. On the other hand, the estimated values of transfer errors for the same settings in the conditional logit model were 21.93%, 109.31% and 43.08%, respectively. The transfer error values thus validate the transfer of benefits across all the sub-basins of the river. Therefore, the current findings are helpful in proper management of ecosystem services and permit for benefit transfer from one sub-basin to another sub-basin of Heihe River.

Willingness to pay for a group and an individual version of the Lifestyle-integrated Functional Exercise program from a participant perspective

BACKGROUND

Perceived benefits of intervention programs from a participant perspective can be examined by assessing their willingness to pay (WTP). Aiming to support decision-makers in their decision to implement a fall prevention program, this study examined (1) the WTP for a group-based and an individually delivered fall prevention program, (2) which factors influence WTP, and (3) whether the WTP exceeds the intervention costs.

METHODS

WTP was elicited using Payment Cards from 237 individuals who participated in a randomized non-inferiority trial (LiFE-is-LiFE) comparing a group version of the Lifestyle-integrated Functional Exercise program (gLiFE) with the individually delivered version (LiFE). Linear regression models were used to examine factors associated with WTP. The net benefit for (g)LiFE was calculated as the difference between WTP and intervention costs, assuming different scenarios of intervention costs (varying group sizes of gLiFE) and hypothetical subsidy levels by a payer (€0, €50, or €75).

RESULTS

The mean WTP was €196 (95% CI [172, 221]) for gLiFE and €228 (95% CI [204, 251]) for LiFE. In the linear regression model, WTP was significantly associated with delivery format (-€32, 95% CI [- 65, - 0.2], for gLiFE) and net household income (+ 68€, 95% CI [23, 113], for ≥€3000 compared to <€2000). The net benefit for gLiFE was positive in most cases. Due to higher intervention costs of LiFE compared to gLiFE (€298 vs. €113), the net benefit for LiFE was negative for the majority of the sample, even at a subsidy of €75.

CONCLUSION

The results provide insight into how valuable the interventions are perceived by the participants and thereby may be used by decision-makers as complement to cost-effectiveness analyses. WTP for both programs was generally high, probably indicating that participants perceived the intervention as quite valuable. However, further research is needed on the WTP and net benefit of fall prevention programs, as results relied on the specific context of the LiFE-is-LiFE trial.

A travel cost recreation demand model examining the economic benefits of acid mine drainage remediation to trout anglers

Acid mine drainage (AMD) is a global environmental problem which has well-documented effects on the physical, chemical, biological, and ecological characteristics of waterways. Less well examined are the economic benefits generated by costly AMD remediation efforts. This research examines trout angler willingness-to-pay (WTP) to maintain fisheries quality benefits resulting from AMD remediation on the North Branch of the Potomac River (NBPR), Maryland. The NBPR has a history of severe AMD-related degradation previously rendering the waterbody unsuitable for many outdoor recreational activities such as trout fishing. However, extensive NBPR AMD remediation activities including nine automated limestone dosers that neutralize acidic water and improve water quality have been critical to developing and maintaining a high quality recreational trout fishery with hatchery-raised stocked trout and naturally reproducing populations of wild trout. To examine trout angler WTP to maintain current NBPR trout fishing quality and hence avoid plausible fishing quality reductions associated with the elimination of nine NBPR limestone dosers, a travel cost recreation demand model of trout angler fishing site choice was developed using data from a survey of Maryland non-tidal anglers. Model results reveal that annual Maryland trout angler WTP to maintain current NBPR trout stocking levels and wild trout abundance, relative to the elimination of the NBPR as a trout fishing site, is about $850,000. These economic benefits to a single stakeholder group - Maryland trout anglers - exceeds the total estimated $340,000 in annual operations and maintenance costs associated with all Maryland limestone dosers. While the positive net economic benefits produced by limestone dosers provide a justification for continuing annual limestone doser expenditures, it's important to note that total economic benefits are likely much higher, as many non-trout fishing benefits remain unaccounted for in this analysis. The approach in this manuscript can serve as a model for practitioners regarding the use of fisheries data and recreational fisher site choice to estimate fishing-related economic benefits from past or for future AMD remediation activities. Given anticipated substantial investments in AMD remediation, additional research in this area is much needed to evaluate past and guide future remediation activities.

Willingness to pay for health gains from an international integrated early warning system for infectious disease outbreaks

Recently, due to the corona virus outbreak, pandemics and their effects have been at the forefront of the research agenda. However, estimates of the perceived value of early warning systems (EWSs) for identifying, containing, and mitigating outbreaks remain scarce. This paper aims to show how potential health gains due to an international EWS might be valued. This paper reports on a study into willingness to pay (WTP) in six European countries for health gains due to an EWS. The context in which health is gained, those affected, and the reduction in risk of contracting the disease generated by the EWS are varied across seven scenarios. Using linear regression, we analyse this 'augmented' willingness to pay for a QALY (WTP-Q) for each of the scenarios, where 'augmented' refers to the possible inclusion of context specific elements of value, such as feelings of safety. An initial WTP-Q estimate for the basic scenario is €17,400. This can be interpreted as a threshold for investment per QALY into an EWS. Overall, WTP estimates move in the expected directions (e.g. higher risk reduction leads to higher WTP). However, changes in respondents' WTP for reductions in risk were not proportional to the magnitude of the change in risk reduction. This study provided estimates of the monetary value of health gains in the context of a pandemic under seven scenarios which differ in terms of outcome, risk reduction and those affected. It also highlights the importance of future research into optimal ways of eliciting thresholds for investments in public health interventions.

Citizens' preferences on green infrastructure practices and their enhancement in Portland, Oregon

Green infrastructure (GI) has been gaining increasing attention due to its efficiency in controlling and purifying urban stormwater runoff, creating environmental amenities, and biodiversity conservation. Nevertheless, the existing knowledge of people's preferences for GI is not yet sufficient for evidence-based policymaking for enhancing GI. This study analyzes citizens' perceptions of the relative importance of six GI practices and estimates their willingness to pay (WTP) to enhance them. To this end, the study applies two types of stated preference methods (best-worst scaling and contingent valuation) to citizen survey data collected in Portland, Oregon. We found that GI practices that are more likely to lead to private benefits (e.g., rain barrels, urban trees) received relatively higher ratings, whereas the ratings of practices that do not offer such benefits (e.g., bioswales, rain gardens) were relatively lower. However, the diversity of preferences was large, as the relative importance varied widely among respondents. Heterogeneous preferences were also found in terms of citizens' WTP for hypothetical GI enhancement. Our comparison of uniform and variable payment schemes revealed that variable payment outperformed uniform payment because of the significant variation in citizens' WTP. The difference was large when the annual household payment was small.

Willingness to pay for COVID-19 vaccines in Jordan: Applying the health belief model

BACKGROUND

To date, there is no effective treatment for COVID-19. Vaccines are effective and safe strategies to control the pandemic.

OBJECTIVE

To measure consumers' maximum willingness to pay (WTP) for COVID-19 vaccines in Jordan and to identify the predictors of WTP.

METHOD

An online survey was used to collect data related to sociodemographic factors and constructs from the Health Belief Model (HBM). The contingent valuation method using the payment card approach was used, whereby the respondents were asked to choose their maximum WTP value from a range of 5-200 Jordanian Dinar (JOD). The maximum WTP values were then categorized into several groups, and an ordered logistic model was used to generate adjusted odds ratios and estimate the significant predictors of maximum WTP.

RESULTS

A total of 3116 respondents completed the survey. More than half of the sample were not willing to pay out of pocket for the vaccine (57%). Among the respondents who were willing to pay any amount above zero, the mean maximum WTP was 28.1 JOD (39.63 USD), and the median WTP was 20 JOD (28.21 USD). The significant predictors of higher WTP values were being of younger age, higher income, being a healthcare provider, having one or more chronic diseases, previous history of receiving the seasonal influenza vaccine, having a family member/friend who has died from the COVID-19, lower perceived risk of the vaccine, higher perceived benefits of the vaccine, and having been recommended to get the vaccine.

CONCLUSION

It is recommended to continue providing the vaccine free of charge to increase its uptake. Educational campaigns should focus on refuting myths related to the vaccine and promoting the benefits of receiving the vaccine in slowing the spread of the pandemic, and improving the economy. Healthcare providers' recommendations have the potential to increase WTP for the vaccine.

The effect of joint prevention and control plan on atmospheric pollution governance and residents' willingness to pay

This study investigates the governance effect of China's joint prevention and control of atmospheric pollution (JPCAP) plan and residents' willingness to pay for clean air. First, this study delves into the JPCAP plan's atmospheric pollution governance effect using the difference-in-difference and spatial difference-in-difference models. The results showed that the atmospheric pollution in Beijing-Tianjin-Hebei (BTH) and surrounding cities have significant spatial autocorrelation characteristics. From the autumn and winter of 2017 to 2019, the JPCAP plan implemented by BTH atmospheric pollution transmission channel cities significantly reduced atmospheric pollution. However, the atmospheric pollution governance effect of the JPCAP plan is weaker in 2018-2019 than in 2017-2018. Second, this study introduced the air quality index and three atmospheric pollutants-PM2.5, NO2, and SO2-into the hedonic price model and investigated the residents' willingness to pay by employing the spatial error model and spatial lag model. Finally, subsample and quantile regression were used to discuss the heterogeneity of residents' willingness to pay. The results show that the reduction in atmospheric pollution increases residents' willingness to pay for clean air. Residents have different willingness to pay for reducing different atmospheric pollutants, and there is heterogeneity in willingness to pay across regions and consumption levels. Residents in areas with the JPCAP plan have a higher willingness to pay than those without the JPCAP plan, and there is no spatial autocorrelation characteristic of the willingness to pay of residents in BTH and surrounding cities.

Health impacts of air pollution in Chinese coal-based clean energy industry: LCA-based and WTP-oriented modeling

The evolution of energy system occupies an important position in economic development and quality of life. Influenced by the energy endowment in China, developing the coal-based clean energy industry has been regarded as a guaranteed path to realizing the clean and efficient use of coal resources. However, an evaluation paradigm that could systematically assess the health impacts of airborne pollution in this industry is still lacking, which is our concern. Combining with life cycle analysis, probabilistic risk models, and health impact models, this study proposes a series of models which are consistent enough to unite pollutant concentration, health risk, and health impact, and equip assessment results with more intuitive significance of life and economic loss. Further, case studies for three typical clean coal technologies, namely, coal mining, coal-fired power generation, and coal liquefaction, are presented to verify the reliability of these models. Results show that the most severe health impact occurred at the worksite of driving face, the substage of coal combustion, and coal mining and processing, respectively, for the three technologies. Further, coal dust brought about the greatest pollution to coal mining and coal liquefaction, and for coal-fired power generation, SO₂, NO₂, and PM₁₀ were the commonest and toughest pollutants. In conclusion, the proposed evaluation paradigm can help to find out the worksite, substage, and airborne pollutant with the most severe impact and is more intuitive to provide references for minimizing or eliminating environmental pollution. Additionally, three aspects of implications are confirmed in this study, namely, social mobilization promoting, government policy making, and environmental pollution prejudging.

Willingness to pay for adopting conservation tillage technologies in wheat cultivation: policy options for small-scale farmers

Traditional farming involves intensive tillage causing soil degradation and erosion. On the contrary, conservation tillage technologies are expensive to purchase for small-scale farmers. However, the adoption of these technologies reduces soil tillage costs which lead to reduced overall production costs. In this milieu, this study assessed the willingness to pay (WTP) for adopting conservation tillage technologies in terms of individual and cooperative payment systems using the primary data collected from 320 wheat farmers in Bangladesh. The contingency valuation method (CVM) was followed to estimate their WTP, and factors affecting WTP were identified through the logistic regression model. The results elicited farmers perceived that conservation tillage technologies would facilitate by reducing costs, timely land preparation, seed sowing and planting, appropriate positioning of seed and fertilizers, and higher soil moisture. Nevertheless, most of the farmers wanted to adopt conservation tillage technologies, while about 79% would like to pay for it. Although farmers' average WTP for individual purchases was higher, most were interested in the cooperative systems for adopting conservation tillage machines. Farmers' WTP for both individual and cooperative purchases was influenced by location of wheat production, farming experience, and demonstration plots. Additionally, individual payment system was affected by the amount of wheatland and training while credit affected the cooperative purchase system. Besides, the farmers would like to expand their wheat farms by approximately 73.33% after adopting conservation tillage technologies. The refusal to pay for conservation tillage technologies was mostly due to low-quality spare parts, lack of technical understanding, and unawareness of the technology. This study suggests that providing training among farmers and operators, credit support, and making machines and spare parts available in the nearest markets would support adopting conservation technologies. Besides, cooperative-based payment system should be formed to help small-scale farmers adopt conservation tillage techniques for sustainable agriculture in an environment-friendly way.

Residential open space and the perception of health benefits: How much is the public willing to pay?

Emerging evidence suggests that residential open space (ROS) is beneficial for multiple health outcomes for urban residents. However, the general public's understanding of and demand for the health benefits related to ROS have not been widely explored. This study aims to examine the impact of residents' socioeconomic status and perceptions of landscape health benefits on their willingness to pay (WTP) for ROS and to evaluate the perceived monetary value of different residential landscape elements. An online survey with 1348 respondents was conducted between August 2020 and October 2021 in China using a contingent valuation (CV) method. Respondents perceived the landscape benefits related to mental health to be higher than those related to physical and social health. The perception of landscape health benefits positively affected WTP and the WTP value of ROS. Residents' monthly income was a significant influencing factor for WTP and the latter's value. For individuals with positive WTP, the average annual WTP for ROS was CNY 68.98 (USD 10.81), while for all the respondents, the estimated mean annual WTP for ROS was CNY 91.75 (USD 14.38). Moreover, the estimated WTP for plants was the highest, whereas the WTP for activity spaces was estimated as the lowest. These findings may improve city planners' and community managers' understanding of the perceived value of residential landscapes among the public and help them make effective decisions to build healthy communities.

The effect of online meeting and health screening on business travel: A stated preference case study in Hong Kong

This study quantifies the effects of health control measures at the airport on passenger behaviour related to business travel. A stated preference survey was conducted over potential air travellers in Hong Kong in the context of COVID-19 pandemic. Panel latent class models were estimated to understand passenger preference toward new travel requirements given the applicability of online meeting. Online meeting is applicable in cases where it is a good substitute of air travel and achieves the same outcomes of a trip, and inapplicable otherwise. Empirical results indicate that traveller subgroups are affected in different ways. When an online meeting is inapplicable, nearly 75% of the respondents prefer to travel for business and undertake health screenings. These passengers (identified as "captive" business travellers) perceive such measures necessary to lower health related risks during air travel. As such, they are willing to spend up to 21 to 38 min on the health control measures such as vaccination record requirements and test involving sample collection. When an online meeting is applicable, the share of "choice" business travellers is about 45%, among whom the attitudes towards health control measures become more averse. The average weighted willingness-to-pay for the time saved at health checkpoints increase significantly. The aviation industry thus faces a "double-hit" problem: operation costs will increase due to pandemic control measures, and the resultant inconvenience, extra time and costs further reduces travel demand. Unlike previous short pandemics, business travel is likely to suffer with an extended decline until the pandemic is fully controlled. These identified challenges call for financial and operational support to help the aviation industry reach a sustainable "new normal". The high value of time saved at check points also justifies investments that make the pandemic control and health measures efficient and smooth. Travellers' time spent on airport health control should be within 20 min to avoid substantial negative impacts on business travel demand.

Willingness-to-pay for cancer treatment and outcome: a systematic review

BACKGROUND

Understanding patient preferences in cancer management is essential for shared decision-making. Patient or societal willingness-to-pay (WTP) for desired outcomes in cancer management represents their preferences and values of these outcomes.

OBJECTIVE

The aim of this systematic review is to critically evaluate how current literature has addressed WTP in relation to cancer treatment and achievement of outcomes.

METHODS

Seven databases were searched from inception until 2 March 2021 to include studies with primary data of WTP values for cancer treatments or achievement of outcomes that were elicited using stated preference methods.

RESULTS

Fifty-four studies were included in this review. All studies were published after year 2000 and more than 90% of the studies were conducted in high-income countries. Sample size of the studies ranged from 35 to 2040, with patient being the most studied population. There was a near even distribution between studies using contingent valuation and discrete choice experiment. Based on the included studies, the highest WTP values were for a quality-adjusted life year (QALY) ($11,498-$589,822), followed by 1-year survival ($3-$198,576), quality of life (QoL) improvement ($5531-$139,499), and pain reduction ($79-$94,662). Current empirical evidence suggested that improvement in QoL and pain reduction had comparable weights to survival in cancer management.

CONCLUSION

This systematic review provides a summary on stated preference studies that elicited patient preferences via WTP and summarised their respective values. Respondents in this review had comparable WTP for 1-year survival and QoL, suggesting that improvement in QoL should be emphasised together with survival in cancer management.

The demand for a COVID-19 vaccine

Taking willingness to pay as primitive, this paper establishes an analytical framework for demand estimation, where the estimator is robust to endogeneity of price. Applying the framework, this paper then estimates demand functions for a COVID-19 vaccine and compute the consumer surplus in both China and the UAE. We find that the price elasticities of demand are mostly greater than one in both countries. An elastic demand suggests subsidy is likely to be successful in promoting vaccination. The consumer surplus is sizeable, around 58 billion US$ in China and 646 million US$ in the UAE. The figures can inform policymakers in assessing their vaccine programs.

Cost-benefit analysis of kidney transplant in patients with chronic kidney disease: a case study in Iran

Background

Chronic kidney disease (CKD) is a health problem due to its increasing prevalence and imposes a significant economic burden on the health system. This study aimed to analyze the cost–benefit of kidney transplantation through the valuation of patients with ESRD for a kidney transplant and its costs to help decide this regard.

Material and methods

This study was a descriptive-analytical and cross-sectional economic evaluation study of health interventions performed in Imam Khomeini Hospital in Urmia from the patient’s perspective. The records of kidney recipients were used to calculate the direct costs of kidney transplantation based on the government tariff rate in 2021. The willingness to pay for kidney transplantation (benefit) was measured through a questionnaire and with a contingent valuation method from 266 samples of patients with ESRD. The questionnaire designed by the researchers had four scenarios with different chances for kidney transplant success. Validation and test–retest methods were used to check the validity and reliability of the questionnaire. Stata software was used to estimate the regression of the factors affecting the willingness to pay and the kidney transplant demand function.

Results

The average cost of a kidney transplant was $877.4. The average willingness to pay for a kidney transplant for four scenarios was estimated at $4733. The mean cost–benefit ratio (BCR) and net present value (NPV) for the four kidney transplant scenarios were 5.39 and $3855. The variables of employment status, awareness of kidney function, number of years with ESRD, insurance coverage, and patients’ income significantly affected their willingness to pay. However, the effect of other variables was not significant. The absolute value of price elasticity of kidney transplant demand was also equal to 2.13.

Conclusion

According to the cost–benefit analysis indexes, the study results showed that a kidney transplant has a net positive benefit for all levels of its probability of success, so the willingness to pay or valuation of patients is about five times the cost of a kidney transplant. Also, the demand for kidney transplantation shows the high sensitivity of the demand for this service to the price. Therefore, preparations for kidney transplantation in patients with ESRD should be considered in situations where the price and cost of transplantation change. The results can help health policy-makers decide to allocate financial resources more efficiently.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12962-022-00372-1.

Willingness to pay for social health insurance and its associated factors among public servants in Addis Ababa, Ethiopia: a cross-sectional study

Background

As a means of establishing a sustained and fair health care financing system, Ethiopia has planned and ratified a legal framework to introduce a social health insurance program for employees of the formal sector to protect them against financial and health burdens. However, the implementation has been delayed due to the resistance of public servants to pay the proposed premium. The aim of this study was to estimate the magnitude of willingness to pay the proposed amount of premium set by the government for the social health insurance program and the factors associated with it among public servants in Addis Ababa, Ethiopia.

Methods

An institution-based cross-sectional study design was used to conduct the study. Multistage sampling was employed to select a total of 503 from 12 randomly selected public sectors. Data were collected using pretested, interviewer-administered structured questionnaires. A contingent valuation method with an iterative bidding game was used to elicit willingness to pay. Finally, logistic regression analysis was used to identify independent predictors of willingness to pay. Statistical significance was considered at P < 0.05 with adjusted odds ratios calculated at 95% CIs.

Results

Only 35.4% were willing to pay the proposed premium (3% of their monthly salary). Those who had children from 6–18 years old (AOR = 3.252; 95% CI: 1.15, 9.22), had a history of unaffordable health service costs during the last 12 months (AOR = 9.631; 95% CI: 4.12, 22.52), and had prior information about the social health insurance program (AOR = 11.011, 95% CI. 3.735–32.462) were more likely to pay for the proposed social health insurance program compared to their counterparts.

Conclusion

The willingness to pay the proposed amount premium for social health insurance among public servants in Addis Ababa was very low that implies the implementation will be challenging. Thus, the government of Ethiopia should consider reviewing the amount of premium contributions expected from employees before implementing the social health insurance scheme.

Preferences for in-kind and in-cash home care insurance

We study preferences for different types of home care insurance using a discrete choice experiment. We consider domestic, personal, and social care, a home care annuity, and a lump-sum for home adaptations. To understand variation in preferences, we relate willingness to pay to personal circumstances, preferences, and expectations. We find that the majority value in-kind and in-cash insurance above the actuarial premium. While most respondents value coverage for basic levels of support, we find diminishing marginal utility for higher levels of support. For in-kind care, willingness to pay is positively associated with respondent characteristics: being single, household income, home ownership, risk aversion, low bequest motives, expected length of home care use, expected expenditures when in need of care, and low expected availability of informal care. In contrast, in-cash support is valued regardless of respondent characteristics, possibly because its inherent flexibility. These results contribute to the design of insurance schemes for home care.

Financing COVID-19 vaccination in sub-Saharan Africa: lessons from a nation-wide willingness to pay (WTP) survey in Ghana

BACKGROUND

Over 13 million doses of the corona virus disease, 2019 (COVID-19) vaccines have been administered in Ghana as at March, 2022; 28.5% of the population have received one dose while 16.3% have been fully vaccinated. Cost associated with COVID-19 vaccinations in low- and middle-income countries (LMICs) requires rethinking on sustainable funding arrangements to consolidate gains made towards containing the COVID-19 pandemic.

OBJECTIVE

Ascertain the determinants of willingness to pay (WTP) for COVID-19 vaccination among adult eligible population in Ghana, and prefer evidence-based policy recommendations on sustainable financing regime for COVID-19 vaccination in the global south.

METHODS

Setting/design: A cross-sectional web-based survey was conducted among adult population aged 18 years and above across the sixteen (16) administrative regions of Ghana.

PARTICIPANTS

A sub-sample of 697 participants willing to receive the COVID-19 vaccine was used as the unit of analysis.

OUTCOME MEASURES

main outcome measures of interests were willingness to pay for COVID-19 vaccination and the specific amount respondents were willing to pay. The odds of WTP and specific amount were predicted using the step-wise backward logistic regression and backward step-wise OLS, respectively.

RESULTS

A total of 2,107 adult respondents aged 18 years and above were reached out to answer the questionnaire; 1,556 successfully completed the questionnaire, representing 74% response rate. Out of the 1,556 valid responses, 697 said they will receive the COVID-19 vaccine. Out of the 697 sub-sample willing to accept the vaccine, 386 (55%) were willing to pay an average of US$6.00 for the vaccine. Positive predictors of WTP were: being an educated male (OR = 0.55, 95% [CI = 0.366, 0.826], p = 0.004), married and educated (OR = 2.19, 95% [CI = 1.077, 4.445], p = 0.030), being a married health worker (OR = 0.43, 95% [CI = 0.217, 0.845], p = 0.015), and having positive perception of the vaccine (OR = 2.40, 95% [CI = 1.144, 5.054], p = 0.021). High WTP amounts correlated positively with adherence to COVID-19 prevention protocols (Coef. = 10.30, 95% [CI = 0.463, 20.137], p = 0.040) and being a health worker with tertiary education (Coef. = 56.339, 95% [CI = 8.524, 104.154], p = 0.021). Christians who are also health workers by occupation were less likely to pay higher amounts for the vaccine (Coef. = -71.431, 95% [CI = 118.821, -24.040], p = 0.003).

CONCLUSIONS

WTP for COVID-19 vaccination in Ghana is low relative to comparative studies in the sub-region. There is the need for accelerated, advocacy and public education on the benefits of vaccination. Likewise, there should be broader stakeholder engagement and national dialogue on sustainable financing options for COVID-19 vaccination as donor support continues to dwindle for LIMCs like Ghana.

Consumer demand for novel fruit and vegetable products with extended shelf lives in East Africa: a multinational multi-product analysis

OBJECTIVE

To evaluate the potential of products made out of underutilised fruits and vegetables for closing seasonal nutritional gaps among rural and urban consumers in East Africa.

DESIGN

The multinational analysis combines sensory testing and experimental auctions to assess consumers' perceptions and willingness to pay (WTP) for 6 different fruit and vegetable products.

SETTING

Open markets in rural and urban areas in Kenya, Tanzania and Uganda.

PARTICIPANTS

There were 939 male and female adults who were at least 18 years old.

RESULTS

Tobit models for each product show that besides sensory perception, similar socio-demographic characteristics influence consumers' WTP for these products in all 3 countries. The products are especially liked among younger, male and urban consumers.

CONCLUSION

We conclude that there is demand and a potential market for processed fruit and vegetable products based on indigenous raw material in East Africa. The products, thus, have promising potential to improve nutrition, especially during off-season conditions when access to fresh produce is limited.

Factors associated to acceptance and willingness to pay for COVID vaccine in Nepal

Introduction

Corona virus disease (COVID-19) remains pandemic globally. Vaccination is considered one of the best means to control both morbidity and mortality of COVID-19. The study aims to find out the people's acceptance and willingness to pay for it.

Methods

The study used cross-sectional survey design. Data were collected using a survey questionnaire from 1072 respondents (age 20-60 years) from 14 districts of Nepal. Socio-demographic characteristics of the respondents were independent and acceptance of vaccine was the dependent variable.

Results

The study found that 84% of the respondents accepted the COVID vaccine. Only one out of six did not accept the COVID vaccine while 16% of the respondents stated that they would like to pay for the COVID vaccination. The average willingness to pay (WTP) for vaccination was NRs. 1053 (US$ 9) while median and mode remained the same NRs. 500. The middle age groups (30-49 years), respondents belonged to Madhesi, business people in terms of occupation and the respondents who had completed school level education had a higher acceptance rate than other categories. It was observed that place of residence in terms of provinces or districts, age group, caste/ethnicity, and educational level of the respondents were significantly associated with the acceptance of the COVID vaccine. Moreover, respondents residing from Lumbini Province, age group of 30-39 years, and having secondary or higher education were noticed as more likely to accept the COVID vaccine than the respective compared groups.

Conclusion

Appropriate information, education and communication needs to disseminate to minimize the misinformation about the COVID and lack of trust in vaccine that may lead to low acceptance and poor WTP for vaccine. These findings could be considered while making COVID and the COVID vaccine-related interventions.

Preferences for oral nutritional supplement therapy among postoperative patients with gastric cancer: a discrete choice experiment

Purposes

Patients after gastrectomy have poor compliance with oral nutritional supplement (ONS) therapy. Incorporating patient preferences into treatment decisions allows possible product improvements or treatment focus adjustments. The purpose of this research was to investigate the preferences for ONS therapy among postoperative patients with gastric cancer, and to provide person-centered oral nutrition management strategies.

Methods

A discrete choice experiment was designed and implemented within a Chinese cancer population. The survey was administered via paper-based questionnaires during face-to-face interviews with assistance from health professionals. A mixed logit model was used to estimate respondents’ preferences for different levels of nutrition therapy attributes.

Results

One hundred ninety respondents valued “Adverse reactions-almost none” (β 3.43 [SE, 0.28]) the most, followed by “Flavor-good taste” (β 0.68 [SE, 0.13]) and “Follow-up frequency-once every 2 weeks” (β 0.52 [SE, 0.13]), and were willing to pay more for these attribute levels. Respondents would be 93.73% more likely to accept a nutrition therapy program if there were almost no adverse reactions compared to the frequent adverse reactions.

Conclusions

Health professionals should pay attention to the management and prevention of adverse reactions when prescribing nutritional products, and provide diversified ONS products when necessary to meet patient preferences. When formulating intervention strategies, health professionals should also consider the different characteristics of patients, acknowledge the importance of the role of nurse specialists in a novel model of multidisciplinary nutritional care, standardize ONS information, follow up regularly, and encourage patients’ families to participate in daily nutrition care.

Supplementary information

The online version contains supplementary material available at 10.1007/s00520-022-07154-8.

Willingness to pay for a National Health Insurance (NHI) in Saudi Arabia: a cross-sectional study

Background

Healthcare services in Saudi Arabia are provided free of charge to its citizens at the point of use. Recently, however, the government has realized that this model is unsustainable in the long run. Therefore, Saudi decision-makers are seeking to have a sustainable health system through the introduction of a contributory National Health Insurance that require making regular financial contributions from its members.

Objective

This study aims to explore the people’s willingness to pay for a National Health Insurance system in Saudi Arabia. The study also aims to understand the factors affecting their willingness or unwillingness to pay NHI, such as, their demographic and socio-economic characteristics, the type of their usual health care provider, and their satisfaction with the current healthcare services.

Methods

A cross-sectional study design with Contingent Valuation (CV) technique was used to measure the value of National Health Insurance based on an individual’s willingness to pay. The data were collected from 475 participants using an online survey via Google Forms between March 2021 and April 2021. Frequencies, logistic regression, and linear regression, were conducted to answer the research questions.

Results

The number of individuals who was willing to pay for NHI was higher than those who were not willing to pay (62.9, 95% CI = 58.4-67.3%) vs (37.1, 95% CI = 32.7-41.6%). A binomial test found this difference was statistically significant (p < 0.001). There was a significant association between the likelihood of paying for NHI and type of usual healthcare provider (OR = 3.129, 95% CI = 1.943-5.039, p < 0.001); as individuals using public health services were more likely to pay for NHI. Also, with satisfaction with health services (OR = 14.305, 95% CI = 3.240-63.153, p < 0.001), as individuals who were very satisfied with the healthcare services were more likely to pay for NHI. The median amount of money the people were willing to pay as a monthly contribution for NHI was 100 SAR (26.5 USD) with the average being 152 SAR (40 USD). There was a significant association between the maximum amount the participants were willing to pay and age, region, and education. Specifically, 30–39-year-olds were willing to pay more for NHI compared to participants aged 50 or older (ß = 103.55, 95% CI = 26.27- 199.29); participants from central region more than participants from northern region (ß = 70.71,95% CI = 2.14- 138.58); and participants with masters degree more than participants with PhDs (ß = 227.46, 95% CI = 81.59- 399.28).

Conclusion

This study provided some evidence that more people were willing to pay for NHI than those who declined. Individuals who frequently used public health services and were very satisfied with these services were more willing to pay for NHI. Younger population, those with master’s degree, and from the central region were willing to pay more amount of money for NHI. These results could help policy makers shape their decisions and anticipate problems that may arise with NHI implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13353-z.

Identifying what shapes the words and actions of residents' environmentally friendly express packaging: Evidence from a two-stage payment model

Voluntary purchase of environmentally friendly products is crucial to alleviating ecological degradation caused by human activities that revealing residents' payment decision-making mechanism is indispensable. Most current studies do not distinguish residents' payment decision-making behavior as a two-stage process of willingness to pay (WTP) and expected payment (EP), and research on negative factors needs to be deepened. To make up for the shortcomings, this study decomposes residents' environmentally friendly express packaging payment decision-making behavior into WTP and EP, and selects positive and negative antecedent variables. Then, the Double-Hurdle Model is used to explore the effects of variables. The results show that residents' EP is 2.68-3.89 RMB per item. Performance expectancy has a positive effect, and risk perception has a negative effect on WTP and EP. Additionally, influencing factors of WTP and EP differ, with facilitating conditions enhancing WTP, while social influence and green advertising acceptance promoting EP. Interestingly, effort expectancy has a positive impact on WTP but a negative effect on EP. Female residents with higher education and family monthly income have higher WTP and EP. The research shed light on residents' payment and recommendations on the promotion of environmentally friendly products are further proposed.

Valuing ecosystem services of sustainable urban drainage systems: A discrete choice experiment to elicit preferences and willingness to pay

Sustainable urban drainage systems (SUDS) address stormwater management issues and provide a variety of benefits to residents in terms of ecosystem services. Economically valuing the non-monetary ecosystem services often proves difficult, as limited markets for SUDS measures exist, rendering revealed preference methods inapplicable. We conducted a discrete choice experiment to elicit the preferences and willingness to pay of the ecosystem services of SUDS in Berlin, Germany. Results from a latent class model indicated how residents weigh the different ecosystem services and that they garner the highest utility in improved water quality from reduced fish die-offs. With these results, practitioners and policy makers can better prioritize measures and make strong economic arguments for SUDS implementation and increasing the provision of ecosystem services.

Lifestyle, psychological and socio-demographic drivers in functional food choice: a systematic literature review based on bibliometric and network analysis

Food-related diseases are a topic of concern for the population and institutions; therefore, regulations have been envisaged to improve consumer knowledge about food properties and to guide them towards healthy food consumption. Europe has addressed the use of claims on labels with two important regulations in 2006 and 2012. The use of claims allows for the differentiation of food products, particularly functional foods, i.e., those that can provide health benefits as part of a standard diet. The study aims to describe the interest of researchers on the topic of functional foods and health claims by observing the trend of publications and highlighting the role of the country on the topic through a network analysis. Another objective is to evaluate the role of lifestyle, psychological and socio-demographic predictors in the choice of functional foods bearing label claims or not, using a systematic literature review. To this aims, a bibliometric and a network analysis were assessed. The results reveal a positive trend in publications and a growing interest in the topic, thus showing that socio-demographic characteristics and lifestyle variables partially influence consumer behaviour. In particular, it emerges that educated people and women are more interested in functional foods, showing a higher willingness to pay for them. In addition, physical activity and beliefs regarding the nutritional quality of functional foods are positively correlated with WTP. However, several contradictory results were observed for some variables in the collected studies. For these reasons and considering the high number of functional foods and claims yet to be evaluated, further investigations are recommended.

Survey data on public perceptions towards flying cars and flying taxi services

An online survey was conducted to evaluate public perceptions towards an emerging transportation technology, namely the flying car, which is expected to join the existing traffic fleet within the following decades. Responses from 692 survey participants were collected. Approximately 84% of the participants were from the United States, and the remaining 16% were from the rest of the world. The data resulting from the survey include several aspects of public perceptions towards flying cars, as for example: willingness to use and pay for flying cars; willingness to use and pay for flying taxi services; perceptions towards potential benefits and concerns arising from the future use of flying cars; perceptions towards considering residence relocation; and perceptions towards potential security measures to improve operational safety of flying cars. In addition, information relating to several dimensions of driving and travel behaviours and habits, and socio-demographic information of the participants were also collected. The dataset can be used as a baseline to design future surveys on Advanced Air Mobility (AAM) and flying cars, and to compare consumer perceptions across different regions and during different time periods.

Estimation of the monetary value of biodiversity in the Central Alborz Protected Area

Biodiversity refers to genetic diversity and complex sets of communities and ecosystems. Environmental degradation can jeopardize biodiversity and decrease ecosystem service quality. Biodiversity is not an endless and free commodity, and the costs of its destruction must be taken into account. Thus, estimating the monetary value of a region's biodiversity can help stakeholders understand its economic, social, and cultural status, and ultimately, by increasing public awareness, community demands for protection and investment are properly shaped. This study aims to estimate the monetary value of biodiversity in the Central Alborz Protected Area in Iran. This area is part of the Alborz Mountain range and the wildlife and plant species of this region have a unique biodiversity. For this purpose, the willingness to pay was estimated. In designing the Choice Experiment, five attributes including "wildlife species status," "plant species status," "natural landscape," "research facilities," and "tourism facilities" have been considered. The results showed that maintaining and improving the status of animal species and tourism conditions among respondents has a higher priority than the other three attributes. The annual value of marginal willingness to pay was 13020 Tomans per person and the conservation value of biodiversity is estimated at 23 billion Tomans. Also, the results of the simple Logit model showed that the average per capita willingness to pay the respondents to protect the region is 16,369 Tomans and the value of biodiversity protection is about 28.6 billion Tomans.

Life cycle assessment and society willingness to pay indexes of food waste-to-energy strategies

Food waste (FW) has received increasing attention because of its immense production quantities and significance to resource and environmental impacts related to disposal approaches. We combined life cycle assessment (LCA) with society's willingness to pay (WTP) index to evaluate energy, water, and environmental impacts on three food waste-to-energy (FWTE) options in China. For anaerobic digestion (AD) mode, the results showed that 1140 MJ of energy consumption could be saved by power generation from methane, power transmission, and biodiesel production from per ton of FW; the cost of climate change for treating FW was 137.8 kg CO₂e t^-1 FW, failing to be climate-sound due to the end life of digestate in practice. The total impact to AD mode in the form of monetized value for WTP was 13.3 CNY t^-1 FW, of which the collection and transportation, pretreatment, AD reaction, wastewater treatment, biodiesel production, and residue landfilling stages contributed by 10.5%, 6.5%, 19.3%, 27.6%, 4.7%, and 75.7%, respectively, while biogas utilization offset it by 43.9%. Notably, a considerable amount of water used in AD prevented it from showing an advantage compared to incineration (-5.1 CNY t^-1 FW), which performed best overall attributing to the generated electricity compensated for primary energy demand, water, and terrestrial acidification to a great extent. Landfilling turned out to be an unappealing FW disposal method due to the low landfill gas capture ratio. Given that AD is touted for its environmental benefits, potential approaches-such as developing a reliable and supportive technology to facilitate digestate recycling into agriculture-were discussed to improve its competitiveness and attractiveness. Our study employed a way to accumulate and compare impact indicators to better interpret FW management impacts and advantages, considering energy recovery, resource recycling, and the environment.

Is prevention of suicide worth less? A comparison of the value per statistical life

This paper compares the value per statistical life (VSL) in the context of suicide prevention to that of prevention of traffic fatalities. We conducted a contingent valuation survey with questions on willingness to pay (WTP) in both contexts by administering a web questionnaire to 1038 individuals aged 18 to 80. We conjectured that WTP for a given impact on the number of fatalities would be lower for suicide prevention because suicide, at least to some degree, is the result of individuals' own decisions. However, this hypothesis was not supported by the within- or between-sample estimates of WTP or by responses to direct questions. Hence, no support is provided for the use of a lower valuation of the impact of suicide prevention than for risk-reducing programs in other fields, such as traffic safety. This implies that the same VSL should be used for evaluating suicide prevention interventions and for risk-reducing programs in other policy areas and funds for the prevention of fatalities should be directed to the area with the lowest cost per life saved.

Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression

The use of a threshold for cost-utility studies is of major importance to health authorities for making the best allocation decisions for limited resources. Regarding the increasing number of studies worldwide that seek to establish a value for a quality-adjusted life year (QALY), it is necessary to review these studies to provide a global insight into the literature. A systematic review on willingness to pay (WTP) studies focusing on QALY was conducted in eight databases up to June 26, 2020. From a total of 9991 entries, 39 studies were selected, and 511 observations were extracted for the meta-analysis using the ordinary least squares method. The results showed a predicted mean empirical value of $52,619.39 (95% CI 49,952.59; 55,286.19) per QALY in US dollars for 2018. A 1% increase in income led to an increase of 0.6% in the WTP value, while a 1-year increase in respondent age led to a decrease of 3.3% in the WTP value. Sex, education level and employment status had significant effects on WTP. Compared to face-to-face interviews, surveys conducted by the internet or telephone were more likely to have a significantly higher value of WTP per QALY, while out-of-pocket payment tended to lower the value. The prediction made for the province of Quebec, Canada, provided a QALY value of approximately USD $98,450 (CAD $127,985), which is about 2.3 times its gross domestic product (GDP) per capita in 2018. This study is consistent with the extant literature and will be useful for countries that do not yet have a preference-based survey for the value of a QALY.