151
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Torgerson D, Reid D, Donaldson C, Russell I, Garton M. Absent friends. THE HEALTH SERVICE JOURNAL 1993; 103:33. [PMID: 10130598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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152
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Abstract
In this paper the implications of the support of undergraduate medical education and research for the new NHS market are examined. Inaccuracies in current methods of distribution of the Service Increment for Teaching and Research (SIFTR) and Additional Cost of Teaching and Research (ACTR) monies will have adverse effects. Receipt of too much money results in providers' care being unfairly subsidised while receipt of too little results in providers bearing an unfair burden of the cost of teaching and research. Results are reported from a study in the north east of Scotland with regard to the feasibility of obtaining more accurate estimates of the costs to the NHS of supporting teaching and research. The choice is between potentially accurate, but cumbersome and costly, systems of data collection or the continuation of the current, more arbitrary, approach of allocating monies. A combination of the two is recommended.
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153
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Cairns J, Donaldson C. Introduction to economics in the new NHS. Health Policy 1993; 25:1-7. [PMID: 10129151 DOI: 10.1016/0168-8510(93)90098-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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154
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Abstract
Health authorities and health boards in the UK are required under the provisions of the NHS Act, 1990, to assess the needs of their resident populations for health care and, through contracting, to act as purchasers of services informed by those needs. This paper presents an economic approach to informing the purchaser on priority setting for contracting. For illustrative purposes, the technique is applied to services for elderly people with dementia. The paper demonstrates that an economic approach to needs assessment is both desirable and practicable.
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155
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Abstract
In this paper, the new NHS is put in a global context, comparing the UK internal market arrangements with changes occurring in other health care systems. An assessment is made of whether the new UK NHS will result in more efficient and equitable health care provision than the 'old' NHS. Regarding financing of health care, most countries seem to be moving in the direction of NHS or public-insurance-based systems. New Zealand and The Netherlands are among the few countries attempting to inject competition into health care financing. There is a greater move, globally, towards competition in the provision of services. In terms of allocative efficiency and equity, we believe that, on balance, the new NHS will bring no improvement. Indeed, in terms of equity, it may be detrimental. If there is any improvement, it is likely to be in technical efficiency.
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156
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Torgerson DJ, Garton MJ, Donaldson C, Russell IT, Reid DM. Recruitment methods for screening programmes: trial of an improved method within a regional osteoporosis study. BMJ (CLINICAL RESEARCH ED.) 1993; 307:99. [PMID: 8343737 PMCID: PMC1693496 DOI: 10.1136/bmj.307.6896.99] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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157
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Torgerson DJ, Donaldson C, Garton MJ, Reid DM, Russell IT. Recruitment methods for screening programmes: the price of high compliance. HEALTH ECONOMICS 1993; 2:55-58. [PMID: 8269047 DOI: 10.1002/hec.4730020107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
High population compliance is seen as a prerequisite for an equitable screening service. To achieve high compliance fixed appointments are usually advocated. However, the costs of achieving high compliance have not previously been described. To assess the costs of achieving high compliance we have used a randomised trial of two common appointment methods: 800 women aged 45-49 living within 20 miles of Aberdeen were selected at random from the Community Health Index. They were randomly assigned to receive one of two letters--one offering a fixed appointment, the other inviting them to telephone to make an appointment. For a defined population fixed appointments achieved high compliance but only by reducing the opportunities for screening; for every 100 women screened, 110 additional women were denied the opportunity of a screening test. In contrast the open letters of invitation achieved efficiency by increasing the number of women screened with given resources within a larger population. Thus for screening services with fixed budgets, high compliance is achieved only by screening fewer people.
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158
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Garton M, Torgerson D, Donaldson C, Russell I, Reid D. Recruitment methods for screening programs: Trial of a new method within a regional osteoporosis study. Int J Gynaecol Obstet 1993. [DOI: 10.1016/0020-7292(93)90385-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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159
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Garton M, Torgerson D, Donaldson C, Russell I, Reid D. 92206879 Recruitment methods for screening programmes: Trial of a new method within a regional osteoporosis study. Maturitas 1993. [DOI: 10.1016/0378-5122(93)90139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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160
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Foot AB, Potter MN, Donaldson C, Cornish JM, Wallington TB, Oakhill A, Pamphilon DH. Immune reconstitution after BMT in children. Bone Marrow Transplant 1993; 11:7-13. [PMID: 8431713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Serial assessment of peripheral blood T and B cell recovery and serum immunoglobulins was performed in 19 children for the first year following BMT and compared with normal values established from healthy children. Immunophenotypic analysis on bone marrow was performed in selected cases by Southern blotting of the immunoglobulin heavy chain (IgH) gene. We found no significant differences between T cell-replete or depleted allogeneic bone marrow transplants. Lymphocyte numbers were low until 9 months post-BMT. T cell numbers (CD2, CD3, CD5) were also low until 12 months but B cell numbers (CD19) became normal at 3 months. Both CD4+ and CD8+ T cell subsets were low post-BMT with depression of CD4+ greater and more prolonged than that of CD8+. No overshoot of CD8+ was seen. The principal effect of GVHD or its treatment was further depression of CD4+ cells but with no increase in CD8+; recovery of B cells was also delayed. Recovery of IgG was slow with only six of 11 children reaching an age-adjusted normal level by 1 year, whereas there was more rapid recovery of IgM and IgA. Several children had an increase in lymphocytes of immature appearance in their bone marrow at varying times post-BMT with increased cells of phenotype CD19+, CD10+, HLA-DR+ and TdT+. In each case Southern blotting showed a germline pattern of the IgH indicating a polyclonal early B cell regenerative population.
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161
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Furber SE, Donaldson C. The cost of cervical cancer screening provided by a women's health nurse. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1992; 16:226-31. [PMID: 1482713 DOI: 10.1111/j.1753-6405.1992.tb00059.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examines the cost of cervical cancer screening provided by a women's health nurse. Methods used to estimate the cost of taking a Pap smear were based on the economic principle of opportunity cost. Techniques for estimating the magnitude of some costs were developed specifically for this study because the cost of taking a Pap smear had to be isolated from the costs of other services provided by the women's health nurse. The cost of taking a Pap smear in 1989 was estimated to be between $17.68 and $17.95. A sensitivity analysis was carried out so that the results of this study could be adapted for practices which differ from the women's health nurse's practice in the Mount Druitt and Hawkesbury area of New South Wales. As a result of this analysis, the cost of taking a Pap smear ranged from $14.16 to $38.88, depending on whether the women's health nurse was a Clinical Nurse Consultant or Clinical Nurse Specialist, the number of Pap smears taken, the proportion of clients who come for postnatal examinations, length of consultations and the distance travelled. It should be noted that the cost of taking a Pap smear would rise considerably above $38.88 for women's health nurses working in remote areas.
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162
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Mooney G, Hall J, Donaldson C, Gerard K. Reweighing heat: response to Culyer, van Doorslaer and Wagstaff. JOURNAL OF HEALTH ECONOMICS 1992; 11:199-210. [PMID: 10122979 DOI: 10.1016/0167-6296(92)90036-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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163
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Garton MJ, Torgerson DJ, Donaldson C, Russell IT, Reid DM. Recruitment methods for screening programmes: trial of a new method within a regional osteoporosis study. BMJ (CLINICAL RESEARCH ED.) 1992; 305:82-4. [PMID: 1638251 PMCID: PMC1882614 DOI: 10.1136/bmj.305.6845.82] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate the response rates and operating costs of three recruitment methods within a regional osteoporosis screening programme. DESIGN Randomised trial of three types of invitation letter: one offering fixed appointments with option to change time, one offering fixed appointments but requiring telephoned confirmation of intention to attend, and one inviting recipient to telephone to make an appointment. SETTING Osteoporosis screening unit, Aberdeen. SUBJECTS 1200 women aged 45-49 years living within 32 km of Aberdeen and randomly selected from the community health index. 400 women were randomised to each appointment method. MAIN OUTCOME MEASURES Numbers attending for screening; default rate among women who confirmed appointments; social class of attenders; cost per appointment slot and per completed scan. RESULTS 299 (75%), 277 (69%), and 217 (54%) women were scanned after fixed, confirmable, and open invitations respectively. Women who attended were given a questionnaire, and 694 (87.5%) returned it. No significant differences were found in the social class of attenders among the three methods. Of the 514 women who made or confirmed appointments, 494 attended for a scan. Total costs per scan were 25.00 pounds, 21.40 pounds, and 21.00 pounds for fixed, confirmable, and open invitations respectively. CONCLUSIONS The offer of a fixed appointment requiring telephoned confirmation has the potential to reduce the costs of scanning without exaggerating any social bias or significantly reducing response rates provided that empty appointments can be rebooked at short notice.
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164
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Abstract
In this paper, the effects of using diagnosis-related groups (DRGs) as the basis of a hospital funding mechanism and within a global budgeting mechanism are reviewed. Most forthcoming is the indeterminate effect of DRGs as a funding mechanism. By controlling only the price of hospital care, such systems remain vulnerable to compensatory increases in patient throughout, cost shifting and patient-shifting. Whether the use of DRGs has substantially reduced hospital cost per case is also not clear cut. Effects on patient outcome have not been adequately assessed. At this stage, use of DRGs within a system of global budgeting will simply focus attention on the current average costs of treating cases without consideration of whether such average costs represent efficient clinical practice. Efficient clinical practice is better established through use of less sophisticated techniques, such as clinical budgeting and cost-effectiveness analysis. The failure of more global budgeting in the past has been that patient outcome has not been monitored. Data on outcome are crucial to determining efficiency. Once efficient clinical practice is established through budgeting, DRGs could be calculated according to efficiency criteria rather than current average cost.
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165
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166
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Donaldson C, Mooney G. Needs assessment, priority setting, and contracts for health care: an economic view. BMJ (CLINICAL RESEARCH ED.) 1991; 303:1529-30. [PMID: 1782499 PMCID: PMC1671822 DOI: 10.1136/bmj.303.6816.1529] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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167
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Lloyd P, Lupton D, Donaldson C. Consumerism in the health care setting: an exploratory study of factors underlying the selection and evaluation of primary medical services. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1991; 15:194-201. [PMID: 1932325 DOI: 10.1111/j.1753-6405.1991.tb00334.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Recent policy initiatives in Australia have continued the debate concerning the appropriate model of health care for this country. A market economy model, predicated on the existence of true consumerism, has been promoted by influential organisations to replace the current system. To test the validity of this perception and to explore the level of consumerism which exists in the Australian health care setting, we undertook a cross-sectional survey of general practitioner attenders in the outer western and northern suburbs of Sydney. Three hundred and thirty-three patients from six general practices were polled over a two-week period in March 1990. Far from demonstrating consumerist behaviour (especially the considered selection and evaluation of services), the survey population was strongly attracted to the traditional model of medical care, which is characterised by the trusting and dependent relationship of patients with their doctors.
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168
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Abstract
Despite acceptance of many of the principles justifying government intervention in health care provision and financing, much recent market-based policy in Australia, the USA and the UK has been based on the assumption that patients have the potential to behave as 'good consumers'. Good consumers are patients with the ability and desire to seek out health care of good quality and reasonable cost. In this paper, an exploratory survey of general practice attenders in Western and Northern Sydney is reported. The aim of the survey was to assess the extent to which patients critically select and evaluate their general practitioner, as a good consumer may be expected to do. The results demonstrate a lack of consumer-oriented behaviour both in general and amongst older respondents in particular. If such results hold true, market-based health care policies relying on consumers to judge quality of care are likely to be detrimental to the health of older people.
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169
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Bryan S, Parkin D, Donaldson C. Chiropody and the QALY: a case study in assigning categories of disability and distress to patients. Health Policy 1991; 18:169-85. [PMID: 10113685 DOI: 10.1016/0168-8510(91)90098-i] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Quality adjusted life years (QALYs) are claimed to be a universal means of measuring output from health care interventions. However, existing QALY research has been carried out mainly in 'high-tech', life extending areas of health care. This paper presents an application of QALY measurement to a 'low-tech' life-quality enhancing area of health care, chiropody. Information on changes in quality of life following chiropody interventions was elicited from both practitioners and patients. We found the apparently low benefit, but low cost service of chiropody to be a potentially cost-effective use of NHS resources. Methodological issues are also addressed relating to the assignment of patients to health states, and whether practitioners' or patients' assessments of changes in quality of life should be used.
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170
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Donaldson C, Bond J. Cost of continuing-care facilities in the evaluation of experimental national health service nursing homes. Age Ageing 1991; 20:160-8. [PMID: 1853788 DOI: 10.1093/ageing/20.3.160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In this paper the costing method and results from the UK evaluation of National Health Service (NHS) nursing-home and continuing-care hospital accommodation for elderly people are presented. Results demonstrate that, in deciding on the relative efficiency of NHS nursing-home and hospital accommodation, it should be possible to provide NHS nursing-home care at a cost which is no greater than its hospital counterpart. Cost implications of future developments should be monitored in the possible event that they are set up differently from the NHS nursing homes discussed in this paper. Despite being more costly than private-sector nursing-home accommodation, NHS nursing homes cater for a less able group of people, although some overlap exists. The implications of such results are discussed in the light of the UK Government's recent proposals to reform both the NHS and community care.
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171
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Donaldson C, Gerard K. Minding our Ps and Qs? Financial incentives for efficient hospital behaviour. Health Policy 1991; 17:51-76. [PMID: 10110073 DOI: 10.1016/0168-8510(91)90117-g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this paper, the empirical evidence addressing the particular issue of how hospitals may be reimbursed is reviewed. Most forthcoming is the indeterminate effect of prospective payment systems using diagnosis-related groups as a means of controlling costs. Such systems, by controlling only the price of hospital care, remain vulnerable to compensatory increase in patient throughput, cost-shifting and patient-shifting despite hospital cost per case being reduced. Health maintenance organisations have been shown to reduce hospital costs, but their effects on patients selection and patient outcome are unclear. Selective contracting in California (similar to the U.K. Government's proposed internal market) has also been shown to reduce costs by affecting both the price and quantity of hospital care. But these effects have occurred only in areas with high concentrations of hospitals. Global and clinical budgeting (which control price times quantity) seem to offer the most potential for cost reduction whilst maintaining patient outcome. By monitoring both cost and outcome within clinical budgets it should be possible to reduce wasteful variations in health care and so establish more efficient hospital practice.
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172
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Mooney G, Hall J, Donaldson C, Gerard K. Utilisation as a measure of equity: weighing heat? JOURNAL OF HEALTH ECONOMICS 1991; 10:475-480. [PMID: 10117015 DOI: 10.1016/0167-6296(91)90026-j] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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173
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Lupton D, Donaldson C, Lloyd P. Caveat emptor or blissful ignorance? Patients and the consumerist ethos. Soc Sci Med 1991; 33:559-68. [PMID: 1962227 DOI: 10.1016/0277-9536(91)90213-v] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The notion that consumerist behaviour is, or should be, prevalent amongst individuals seeking health care has underlain recent United States and British governmental policy directives. Consumer groups make similar assumptions when exhorting individuals to treat health care like any other service. This paper enquires to what extent patients conceive of themselves and others as adopting consumerist behaviour when seeking and evaluating primary health care. Three hundred and thirty-three patients attending general practices in Sydney, Australia, were asked in open-ended questions to state why they chose their regular doctor, why they continued to visit that doctor, if they had ever changed their doctor, if they thought most people could tell if a doctor were good or bad, and what qualities they thought constituted a good and bad doctor. It is concluded that the patients surveyed tended not to think of themselves as consumers who should be wary of the quality of service offered by doctors. Rather they preferred to trust their doctor, and therefore did not devote effort to actively seeking out information about their doctor or evaluating his or her services.
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174
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Bond J, Bond S, Gregson B, Donaldson C, Atkinson A. Care of the elderly: nursing homes and continuing care--Part two. Nurs Stand 1990; 4:21-3. [PMID: 2114557 DOI: 10.7748/ns.4.37.21.s35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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175
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Donaldson C. Willingness to pay for publicly-provided goods. A possible measure of benefit? JOURNAL OF HEALTH ECONOMICS 1990; 9:103-118. [PMID: 10113226 DOI: 10.1016/0167-6296(90)90043-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The results presented in this paper arise from a U.K.-based study aimed at determining peoples' willingness to pay for two publicly-provided goods, namely continuing-care for elderly people in either hospital or National Health Service (NHS) nursing homes. Seventy-one per cent of respondents provided evaluations which could contribute to the analysis which showed that the group which preferred NHS nursing-home care could potentially compensate the group which preferred hospital care and still remain better off, thus rendering NHS nursing-home care the efficient option to undertake. No variable could be found which discriminated between those who could place a value on both types of care and those who could not. The willingness-to-pay methodology is very experimental in this context and should be investigated thoroughly before its widespread adoption in the evaluation of health care techniques.
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