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Steigenberger C, Flatscher-Thoeni M, Siebert U, Leiter AM. Determinants of willingness to pay for health services: a systematic review of contingent valuation studies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1455-1482. [PMID: 35166973 PMCID: PMC8853086 DOI: 10.1007/s10198-022-01437-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/12/2022] [Indexed: 05/29/2023]
Abstract
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.
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Affiliation(s)
- Caroline Steigenberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Magdalena Flatscher-Thoeni
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL, Center for Personalized Cancer Medicine, Innsbruck, Austria
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Health Decision Science, Departments of Epidemiology and Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea M Leiter
- Department of Economics, Faculty of Economics and Statistics, University of Innsbruck, Innsbruck, Austria
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Horodnic AV, Williams CC, Drugă RI. The Companion Pandemic to COVID-19: The Use of Informal Practices to Access Public Healthcare Services in the European Union. Int J Public Health 2022; 67:1604405. [DOI: 10.3389/ijph.2022.1604405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The objective of this paper is to evaluate the use of informal payments and personal connections to gain preferential access to public health services during the COVID-19 pandemic and to propose effective policy measures for tackling this phenomenon.Methods: Using data from 25,744 patients in the European Union, six different scenarios are analyzed in relation to making informal payments and/or relying on personal connections to access public healthcare services. To evaluate the propensity to engage in informal practices in healthcare, probit regressions with sample selection and predicted probabilities are used. Robustness checks are also performed to test the reliability of the findings.Results: For each scenario, a statistically significant association is revealed between the propensity to make informal payments and/or rely on personal connections and the asymmetry between the formal rules and the patients’ personal norms and trust in public authorities.Conclusion: To tackle informal practices in healthcare, policy measures are required to reduce the asymmetry between the formal rules and personal norms by raising trust in public authorities.
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Elek P, Csanádi M, Fadgyas-Freyler P, Gervai N, Oross-Bécsi R, Szécsényi-Nagy B, Tatár M, Váradi B, Zemplényi A. Heterogeneous impact of the COVID-19 pandemic on lung, colorectal and breast cancer incidence in Hungary: results from time series and panel data models. BMJ Open 2022; 12:e061941. [PMID: 35981776 PMCID: PMC9393855 DOI: 10.1136/bmjopen-2022-061941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE During the COVID-19 pandemic, health system resources were reallocated to provide care for patients with COVID-19, limiting access for others. Patients themselves also constrained their visits to healthcare providers. In this study, we analysed the heterogeneous effects of the pandemic on the new diagnoses of lung, colorectal and breast cancer in Hungary. DESIGN Time series and panel models of quarterly administrative data, disaggregated by gender, age group and district of residence. PARTICIPANTS Data for the whole population of Hungary between the first quarter of 2017 and the second quarter of 2021. MAIN OUTCOME MEASURES Number of patients newly diagnosed with lung, colorectal and breast cancer, defined as those who were hospitalised with the appropriate primary International Classification of Diseases Tenth Revision diagnosis code but had not had hospital encounters with such a code within the previous 5 years. RESULTS The incidence of lung, colorectal and breast cancer decreased by 14.4% (95% CI 10.8% to 17.8%), 19.9% (95% CI 12.2% to 26.9%) and 15.5% (95% CI 2.5% to 27.0%), respectively, during the examined period of the pandemic, with different time patterns across cancer types. The incidence decreased more among people at least 65 years old than among the younger (p<0.05 for lung cancer and p<0.1 for colorectal cancer). At the district level, both the previously negative income gap in lung cancer incidence and the previously positive income gap in breast cancer incidence significantly narrowed during the pandemic (p<0.05). CONCLUSIONS The decline in new cancer diagnoses, caused by a combination of supply-side and demand-side factors, suggests that some cancer cases have remained hidden. It calls for action by policy makers to engage individuals with high risk of cancer more in accessing healthcare services, to diagnose the disease early and to prepare for effective management of patient pathways from diagnosis to survival or end-of-life care.
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Affiliation(s)
- Peter Elek
- Institute of Economics, Centre for Economic and Regional Studies, Budapest, Hungary
- Institute of Economics, Corvinus University of Budapest, Budapest, Hungary
| | | | | | | | | | - Balázs Szécsényi-Nagy
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
- Community Health Centre, Gyál, Hungary
| | - Manna Tatár
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Balázs Váradi
- Budapest Institute for Policy Analysis, Budapest, Hungary
- Department of Economics, Eötvös Loránd Tudományegyetem, Budapest, Hungary
| | - Antal Zemplényi
- Centre for Health Technology Assessment and Pharmacoeconomic Research, Pécsi Tudományegyetem, Pécs, Hungary
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Hsu W, Yang CH, Fan WP. A Study of Patients' Willingness to Pay for a Basic Outpatient Copayment and Medical Service Quality in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126604. [PMID: 34205325 PMCID: PMC8296397 DOI: 10.3390/ijerph18126604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
Patients might be willing to pay more to obtain better quality medical services when they recognize that high-level hospitals have better quality. However, published papers have not found solid empirical evidence to support this possibility. Therefore, the purpose of this study is to empirically investigate patients’ willingness to pay (WTP) for an outpatient copayment. The study aims to analyze the difference between the two WTP values: to implement a hierarchy of medical care and to improve the quality of medical services. This study administered a questionnaire using the contingent valuation method with a quasi-bidding game for patients’ WTP and the SERVQUAL scale for medical service quality. The Wilcoxon signed-rank test was employed to test the difference between the two WTP values, notably to implement a hierarchy of medical care and to improve the quality of medical services. Both of the WTP values are higher than the academic medical centre’s current copayment NT$420 (approximately US$14); the percentage of respondents willing to pay a higher copayment declined when the outpatient copayment was increased, and the patients’ WTP to have better medical service quality was significantly higher than that to implement a hierarchy of medical care. Patients’ desire to receive better medical services from higher-level hospitals might be stronger than their desire to implement hierarchical medical care. This study reported the relationship between the respondents’ perceived medical service quality and WTP for having better service quality by using regression models. The respondents’ perceptions of medical service quality, especially for “reliability” and “assurance,” would positively affect their WTP. Policy makers should focus on improving the quality of medical services.
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Affiliation(s)
- Wei Hsu
- Department of Health Care Management, National Taipei University of Nursing & Health Sciences, Beitou, Taipei 112303, Taiwan;
- Correspondence:
| | - Chih-Hao Yang
- Department of Accounting, Ming Chuan University, Shilin, Taipei 111005, Taiwan;
| | - Wen-Ping Fan
- Department of Health Care Management, National Taipei University of Nursing & Health Sciences, Beitou, Taipei 112303, Taiwan;
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Giannouchos TV, Ukert B, Vozikis A, Steletou E, Souliotis K. Informal out-of-pocket payments experience and individuals' willingness-to-pay for healthcare services in Greece. Health Policy 2021; 125:693-700. [PMID: 33838935 DOI: 10.1016/j.healthpol.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Informal out-of-pocket payments to healthcare providers are not uncommon in the Greek health system. We explore individuals' willingness-to-pay (WTP) to secure zero out-of-pocket full coverage for healthcare services and medications and we estimate the impact of past informal payments and individuals' opinion about the legalization of informal payments on WTP. METHODS We conducted a survey of 2841 participants from November 2016 to February 2017. We obtained information on WTP using the contingent valuation method. A two-part regression model was used to estimate the association between WTP, informal payments, and respondents' opinion about legalizing such payments. RESULTS About 80% of the respondents were willing to pay an average of €95 per month to obtain free access to full healthcare coverage and medications. About 65% of the respondents were involved in an informal payment at least once during the past four months with an average payment of €247. Higher informal payments and supportive opinions towards the legalization of informal payments increased the likelihood of WTP and were also positively associated with increased WTP amounts overall (p < 0.001). CONCLUSIONS This survey reveals that individuals' WTP is critically affected by previous experiences and attitudes towards informal payments. Our results imply that the potential introduction of official fees might not suffice to limit informal payments and suggest the need for stricter regulatory policies.
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Affiliation(s)
- Theodoros V Giannouchos
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, 30 S 2000 E, Salt Lake City, 84112, UT, USA; Population Informatics Lab, Texas A&M University, 212 Adriance Lab Rd, College Station, 77843, TX, USA; Laboratory of Health Economics & Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Piraeus, Greece.
| | - Benjamin Ukert
- Department of Health Policy & Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, 77843, College Station, TX, USA
| | - Athanassios Vozikis
- Laboratory of Health Economics & Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Piraeus, Greece
| | - Evangelia Steletou
- University Regional General Hospital of Patras, University of Patras, 26504, Patras, Rion, Greece
| | - Kyriakos Souliotis
- Department of Social and Education Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100, Corinth, Greece
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Pourtaleb A, Jafari M, Seyedin H, Akhavan Behbahani A. New insight into the informal patients' payments on the evidence of literature: a systematic review study. BMC Health Serv Res 2020; 20:14. [PMID: 31902368 PMCID: PMC6943960 DOI: 10.1186/s12913-019-4647-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/16/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. METHODS In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. RESULTS Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. CONCLUSION It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.
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Affiliation(s)
- Arefeh Pourtaleb
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Jafari
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Seyedin
- Department of Health in Disaster and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Kaneva M, Gerry CJ, Avxentiev N, Baidin V. Attitudes to reform: Could a cooperative health insurance scheme work in Russia? INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2019; 19:371-394. [PMID: 30671697 DOI: 10.1007/s10754-019-09260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
As for all health systems, in Russia, the demand for medical care is greater than its health system is able to guarantee the supply of. In this context, removing services from the state guaranteed package is an option that is receiving serious consideration. In this paper, we examine the attitudes of the Russian population to such a reform. Exploiting a widely-used methodology, we explore the population's willingness to pay for cooperative health insurance. Distinguishing between socioeconomic and demographic factors, health-related indicators and risk aversion we find, consistent with other literature, positive income and risk aversion effects. We interpret the former as evidence that the Russian population is not opposed to the idea of progressive redistribution, to pool the costs of health-related risks; and the latter as evidence that risk-averse individuals demand more insurance coverage. In exploring these results further, we show that cognitive bias is important: overestimating the benefits leads to the purchase of additional insurance, while underestimating lowers demand for insurance. Our overall conclusion is that the introduction of a supplementary cooperative health insurance scheme in Russia could increase the accessibility of healthcare, lower the tendency for informal payments, incentivize the personal maintenance of good health and create a new source of funding for public healthcare.
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Affiliation(s)
- Maria Kaneva
- International Laboratory for Healthcare Economics and Its Reforms, Gaidar Institute for Economic Policy, Gazetny Pereulok 3-5, Building 1, Office 471, Moscow, Russia, 125993.
- Institute of Economics and Industrial Engineering, Siberian Branch of the Russian Academy of Sciences, 17 Ac. Lavrentieva Prospekt, office 373, Novosibirsk, Russia, 630090.
| | - Christopher J Gerry
- Oxford School of Global and Area Studies (OSGA), University of Oxford, 12 Bevington Road, Oxford, OX2 6LH, UK
| | - Nikolay Avxentiev
- Institute for Social Analysis and Forecasting of The Russian Presidential Academy of National Economy and Public Administration (ISAF RANEPA), Prechistenskaya Naberezhnaya 11, Moscow, Russia, 119034
- Center for Perspective Financial Planning, Macroeconomic Analysis and Financial Statistics, Financial Research Institute of Ministry of Finance, Nastasyinsky Pereulok 3, Building 2, Office 110, Moscow, Russia, 127006
| | - Valerii Baidin
- Center for Fiscal Policy, Financial Research Institute of Ministry of Finance, Nastasyinsky Pereulok 3, Building 2, Office 101, Moscow, Russia, 127006
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Meskarpour Amiri M, Teymourzadeh E, Ravangard R, Bahadori M. Health informal payments and their main determinants: The case of Iran. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818822594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.62319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care? Soc Sci Med 2017; 189:86-95. [DOI: 10.1016/j.socscimed.2017.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 07/09/2017] [Accepted: 07/20/2017] [Indexed: 01/09/2023]
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Baji P, Pavlova M, Gulácsi L, Groot W. Does the Implementation of Official User Charges Help to Eradicate Informal Payments - Lessons to be Learnt from the Hungarian Experience. Front Public Health 2015; 3:181. [PMID: 26236705 PMCID: PMC4505068 DOI: 10.3389/fpubh.2015.00181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/06/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest , Budapest , Hungary ; Center for Economic Research and Graduate Education - Economics Institute (CERGE-EI) , Prague , Czech Republic
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University , Maastricht , Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest , Budapest , Hungary
| | - Wim Groot
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University , Maastricht , Netherlands ; Topinstitute for Evidence-Based Education Research (TIER), Maastricht University , Maastricht , Netherlands
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