Demand assessment and price-elasticity estimation of quality-improved primary health care in Palestine: a contribution from the contingent valuation method

Income and cigarette price responsiveness: evidence from Vietnam

BACKGROUND

Vietnam has an ad valorem tobacco excise structure, with the tax base being factory gate price, making the excise susceptible to tax avoidance and less effective in reducing tobacco use. To address these issues, therefore, the government has considered switching to a mixed system in which a specific rate would be imposed on every cigarette pack in addition to the existing ad valorem rate. However, little is known about how smokers with different incomes respond to price increases in Vietnam, raising the concern of regressivity of the tax reform.

OBJECTIVES

This paper aims to provide timely and more updated evidence to support policy discussion on tobacco excise tax reform.

METHODS

The study relies on the smokers' stated preferences, which are elicited from the Tobacco Consumption Survey in Vietnam in 2017-2018. We use data on actual purchases and the stated maximum prices that smokers are willing to pay for their cigarette brands to calculate conditional price elasticity at the individual level. Regression analysis then is used to quantify the extent to which income and other socioeconomic characteristics shape the smokers' price sensitivity.

RESULTS

Both the individual incomes and household incomes have negative and significant effects on the price elasticity of conditional demand for cigarettes. This effect is particularly strong after taking the product heterogeneity into account by considering only the most popular brand, but becomes smaller when looking at a more heterogeneous market by excluding that brand from the original sample. The magnitude of the impact of income adjusted for cigarette price is much higher than unadjusted income. The implication is that with sufficiently large variation in price across cigarette brands, which are often the case for countries with ad valorem tobacco excise tax structures, the low-income smokers may not be more sensitive to cigarette price than the high-income smokers so that a uniform percentage increase does not necessarily result in larger consumption fall for the low-income smokers. Narrowing the price gaps between cigarette brands by adding a specific tax component can help address this issue.

CONCLUSION

Raising tobacco tax can make the tax policy more progressive and benefit the poor more than the rich in Vietnam. Thus, the Government of Vietnam should switch from the current, purely ad valorem excise tax structure to the mixed system to reduce price variation and make the tobacco tax more progressive.

Determinants and Willingness to Pay for Purchasing Mask against COVID-19: A Protection Motivation Theory Perspective

Currently, coronavirus disease 2019 (COVID-19) is spreading globally, which poses great challenges to the whole world and human beings. The aim of this research is to understand the determinants and residents' willingness to pay (WTP) for purchasing masks against COVID-19 in China. On the basis of protection motivation theory and contingent value method, this research shows that most residents are willing to purchase masks against COVID-19. COVID-19 knowledge, perceived severity, perceived vulnerability, and response efficacy are positively and significantly associated with residents' WTP and the WTP value. However, self-efficacy is only significantly associated with residents' WTP while not with WTP value. Furthermore, compared with other residents, residents in Hubei province have a higher level of COVID-19 knowledge, perceived severity, perceived vulnerability, self-efficacy and response efficacy, and the WTP value is higher. The average value of residents' WTP value for purchasing masks against COVID-19 in Hubei province is ¥120.92 ($18.73) per month during the epidemic, while it is ¥100.16 ($15.50) for other residents. In addition, the effects of demographic factors such as age, gender, income, etc., on residents' WTP and WTP value have also been examined.

Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long Term Effects

Zambia removed user fees in publicly supported-government and faith based- health facilities in 54 out of 72 districts in 2006. This was extended to rural areas of previously unaffected districts in 2007. The natural experiment provided by the step-wise implementation of the removal policy and five waves of nationally representative household survey data enables us to study the impact of the removal policy on utilization and household health expenditure. We find that the policy increased overall use of health services in the short term and the effects were sustained in the long term. The increases were higher for individuals whose household heads were unemployed or had no or less education. The policy also led to a small shift in care seeking from private to publicly supported facilities, an effect driven primarily by individuals whose household heads were either formally employed or engaged in farming. The likelihood of incurring any spending reduced, although this weakened slightly in the long term. At the same time, there was an upward pressure on conditional health expenditure, i.e., expenditure was higher after removal of fees for those who incurred any spending. Hence, total (unconditional) household health expenditure was not significantly affected.

Willingness to pay for publicly financed health care services in Central and Eastern Europe: evidence from six countries based on a contingent valuation method

The increased interest in patient cost-sharing as a measure for sustainable health care financing calls for evidence to support the development of effective patient payment policies. In this paper, we present an application of a stated willingness-to-pay technique, i.e. contingent valuation method, to investigate the consumer's willingness and ability to pay for publicly financed health care services, specifically hospitalisations and consultations with specialists. Contingent valuation data were collected in nationally representative population-based surveys conducted in 2010 in six Central and Eastern European (CEE) countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine) using an identical survey methodology. The results indicate that the majority of health care consumers in the six CEE countries are willing to pay an official fee for publicly financed health care services that are of good quality and quick access. The consumers' willingness to pay is limited by the lack of financial ability to pay for services, and to a lesser extent by objection to pay. Significant differences across the six countries are observed, though. The results illustrate that the contingent valuation method can provide decision-makers with a broad range of information to facilitate cost-sharing policies. Nevertheless, the intrinsic limitations of the method (i.e. its hypothetical nature) and the context of CEE countries call for caution when applying its results.

Willingness and ability to pay for physician services in six Central and Eastern European countries

Patient charges for physician services are implemented in high-income countries and often are considered in the Central and Eastern Europe (CEE). However, there is no evidence on the potential consumption effects of service charges in these countries. This study provides evidence on the potential impact of patient charges on the consumption of specialized physician services in six CEE countries: Bulgaria, Hungary, Lithuania, Poland, Romania, and Ukraine. We apply a semi-parametric survival analysis to stated willingness and ability to pay (WATP) in order to identify potential demand pools and their price, income and age semi-elasticity. Data are collected through a survey held in 2010 among representative samples of about 1000 respondents in each country. Our results suggest that median WATP in the studied countries is comparable to the cost of the services. The obtained demand pools appear to be theoretically valid and externally consistent. They provide information on the shares of population that would be WATP certain fee levels, and their heterogeneity across socio-demographic groups gives an idea about the population groups that will need to be exempted.

Preferences for physician services in Ukraine: a discrete choice experiment

Evidence on preferences of Ukrainian consumers for healthcare improvements can help to design reforms that correspond to societal priorities. This study aims to elicit and to place monetary values on public preferences for out-patient physician services in Ukraine. The method of discrete choice experiment is used on a sample of 303 respondents, representative of the adult Ukrainian population. The random effect logit model with interactions provides the best fit for the data and is used to calculate the marginal willingness to pay (MWTP) for quality and access improvements. At a sample level, there is no clear preference to pay formally rather than informally or vice versa. We also do not find that visiting a general practitioner is preferred over direct access to a medical specialist. However, there are differences between population groups. Quality-related attributes of physician services appear important to respondents, especially the attitude of medical staff. Thus, interpersonal aspects of out-patient care should be given priority in decisions about investments in quality improvements. Other aspects, that is social quality and access, are important as well but their improvement brings fewer social gains. Measures should be taken to eradicate the informal payment channels and to strengthen the gate-keeping role of primary care.

Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature

This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

Willingness to pay for zinc treatment of childhood diarrhoea in a rural population of Bangladesh

INTRODUCTION

Young children in the developing world continue to experience a median of between two and four episodes of diarrhoea each year. To better understand adherence to the WHO/UNICEF-recommended diarrhoea management guidelines, which now include zinc, this study aimed to determine how much caregivers were willing to pay for zinc treatment and to explore the characteristics of actual users of zinc in a rural community of Bangladesh.

METHODS

Initially we conducted a contingent valuation survey among primary caregivers of children aged 6-36 months. We assessed their willingness-to-pay (WTP) for 10 days of zinc treatment per diarrhoea episode at Tk.15 (US$0.26) and at Tk.20 (US$0.34), followed by an open question on the highest WTP amount. Next we conducted a cross-sectional survey in the same area to identify households with children who had received zinc during their most recent diarrhoea episode within the previous 3 months.

RESULTS

Field workers interviewed 111 primary caregivers to explore WTP for zinc in childhood diarrhoea. Of these, 92% were willing to pay US$0.26 and 85% of these positive respondents were also willing to pay US$0.34. The mean WTP was US$0.50. We found that higher socio-economic status, better educated fathers and lower mother's age positively influenced the expressed WTP. Actual users, the 51 households whose child received zinc in their most recent diarrhoea episode, were more likely to have educated parents, higher socio-economic status and to have sought care from qualified providers for diarrhoeal illness.

CONCLUSION

The expressed WTP results indicate a high demand for zinc in childhood diarrhoea management in this rural community of Bangladesh. Safety net measures and targeted communication activities specifically aimed at the poor and less educated population could be beneficial to achieve more equitable use of zinc as part of the standard treatment with oral rehydration solution in childhood diarrhoea management.

The health-care system: an assessment and reform agenda

Attempts to establish a health plan for the occupied Palestinian territory were made before the 1993 Oslo Accords. However, the first official national health plan was published in 1994 and aimed to regulate the health sector and integrate the activities of the four main health-care providers: the Palestinian Ministry of Health, Palestinian non-governmental organisations, the UN Relief and Works Agency, and a cautiously developing private sector. However, a decade and a half later, attempts to create an effective, efficient, and equitable system remain unsuccessful. This failure results from arrangements for health care established by the Israeli military government between 1967 and 1994, the nature of the Palestinian National Authority, which has little authority in practice and has been burdened by inefficiency, cronyism, corruption, and the inappropriate priorities repeatedly set to satisfy the preferences of foreign aid donors. Although similar problems exist elsewhere, in the occupied Palestinian territory they are exacerbated and perpetuated under conditions of military occupation. Developmental approaches integrated with responses to emergencies should be advanced to create a more effective, efficient, and equitable health system, but this process would be difficult under military occupation.