Estimating the willingness to pay for drug abuse treatment: a pilot study

Effects of messaging on public support for drug consumption rooms in scotland, UK

BACKGROUND

There is evidence to suggest that medically supervised drug consumption rooms (DCRs) may form part of responses to reduce drug-related harm. Although DCRs have been established globally, they are perceived by some to be a controversial approach in the UK, and Government has repeatedly rejected proposals to establish one in Glasgow, Scotland. As public support is an important component of policy development and enactment, we sought to investigate the effects of different types of message framing on public support for DCR.

METHODS

We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample. Participants were randomised to one of six message conditions comprising combinations of four components. All conditions included i) a basic description of a DCR, and conditions included combinations of ii) factual information; iii) pre-emptive refutation of common public concerns about DCR; and/or iv) a sympathetic narrative describing a mother whose son died from a heroin overdose. After reading each message, participants completed a bespoke measure assessing support for DCR. Data were analysed using ANCOVA.

RESULTS

Complete data were obtained from 1591 participants (50.3% Female; mean age 44.9 ± 16.1 years). Compared to reading a basic description of DCR alone, there was greater support for DCR in participants receiving the refutation (p < .001); sympathetic + factual (p < .05); and sympathetic + factual + refutation (p < .001) message conditions. Presenting factual or sympathetic messages alone were not associated with increased support.

CONCLUSION

Our findings suggest that public support for DCRs is not improved through communication of factual statements outlining potential benefits of the intervention alone. Advocates seeking to foster public support, and thus influence policy making, should also consider communication campaigns that address common concerns that the public might have about DCRs, and present the intervention in relation to potential benefits that they hold for people indirectly affected by drug-related harm.

Public policy, attitudes and willingness to pay for treatment of substance dependence in Iran

BACKGROUND

Evaluation of costs and benefits of substance use treatment programs through a standard economic framework is necessary for optimal policy making. However, drug policy making is seldom supported by economic justification. Measurement of willingness to pay is a tool to provide better understanding of intangible substance use treatment outcomes and to help a balanced policy in treatment of substance use between maintenance treatment and abstinence-based approach.

AIM

To assess the reciprocal association between economic indexes and attitudes about substance use and its treatment as indicators of tendency toward the two different treatment.

METHOD

Willingness to pay for treatment was measured by contingency valuation method among 109 treatment cost payers of which 78 subjects were from outpatient methadone maintenance clinics and 31 were from abstinence-based residential facilities. To analyze predictors of willingness to pay, we used income to capture heterogeneity of purchasing power among subjects. Further, we checked bivariate correlation of different attitudes of cost payers with willingness to pay. In the next step using backward regression equation we tried to reach the best specification of the model. Selected variables include cost payers' attitudes toward substance use and its treatment, effectiveness of treatment, social attitude toward the condition of substance use in Iran, fairness of treatment prices, and government financial support for addiction treatment.

RESULTS

In methadone maintenance clinics the payers' income had a pivotal role in determining willingness to pay for substance use treatment by 50% (p<0.001 ). On the other hand, in abstinence-based residential facilities positive attitude toward substance use (61%, p<0.01) was the major direct determinant of willingness to pay for treatment. Attitude to public financial support for substance use treatment (55%, p<0.01 ) and consumption experience (45%, p<0.01 ) showed an inverse association with WTP in regression equation.

CONCLUSION

This study expanded the understanding of the nature of payment in different substance use treatment modalities. The suggestion to policy makers is that before taking position on different types of treatment services, it is necessary to pay attention to factors that determine values cost payers put on treatment. In other words, economic indexes, payers' views about substance use and its treatment, and their opinion about effectiveness of substance use treatment programs may jeopardize the success of the policy.

Expanding co-payment for methadone maintenance services in Vietnam: the importance of addressing health and socioeconomic inequalities

BACKGROUND

Ensuring high enrollment while mobilizing resources through co-payment services is critical to the success of the methadone maintenance treatment (MMT) program in Vietnam. This study assessed the willingness of patients to pay (WTP) for different MMT services delivery models and determined its associated factors.

METHODS

A facility based survey was conducted among 1016 MMT patients (98.7% male, 42% aged 35 or less, and 67% living with spouse) in five MMT clinics in Hanoi and Nam Dinh province in 2013. Socioeconomic, HIV and health status, history of drug use and rehabilitation, and MMT experience were interviewed. WTP was assessed using contingent valuation method, including a set of double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay.

RESULTS

95.5% patients were willing to pay for MMT at the monthly mean price of US$ 32 (95%CI = 28-35). Higher WTP was associated with higher level of educational attainment, higher income, male sex, and had high expenses on opiates prior to MMT. Patients who reported having any problem in Pain/ Discomfort, and who did not have outpatient care last year were willing to pay less for MMT than others.

CONCLUSION

High level of WTP supports the co-payment policies as a strategy to mobilize resources for the MMT program in Vietnam. However, it is necessary to ensure equalities across patient groups by acknowledging socioeconomic status of different settings and providing financial supports for disadvantaged patients with severe health status.

Willingness to pay for opioid agonist treatment among opioid dependent people who inject drugs in Ukraine

BACKGROUND

In the context of decreasing external and limited Ukrainian governmental funding for opioid agonist treatments (OAT) for opioid dependent people who inject drugs in Ukraine, information on sustainable financial models is needed.

METHODS

Data on 855 opioid dependent people who inject drugs (PWID) were drawn from a cross-sectional nationwide survey of 1613 PWID. They comprised 434 participants who were receiving OAT and 421 who were on OAT in the past or have never been on OAT and were interested in receiving the treatment. Multivariate logistic regression was used to examine factors associated with willingness-to-pay (WTP) for OAT, stratified by OAT experience. Variation in the price which respondents were willing to pay for OAT and its effect on their monthly income among PWID with different OAT experience were assessed as a continuous variable using one-way ANOVA and Kruskal-Wallis test.

RESULTS

Overall, 378 (44%) expressed WTP for OAT. Factors independently associated with WTP differed by OAT experience. Among those using OAT, independent predictors of WTP included: city (Dnipro - aOR=1.9; 95%CI=1.1-4.8 and Lviv - (aOR=2.2; 95%CI=1.1-4.8) compared to those elsewhere in Ukraine), higher income (aOR=1.8; 95%CI=1.2-2.7) and receiving psychosocial counseling (aOR=1.8; 95%CI=1.2-2.7). Among those who had previously been on OAT, positive attitude towards OAT (aOR=1.3; 95%CI=1.1-1.6) and family support of OAT (aOR=2.5; 95%CI=1.1-5.7) were independently associated with WTP. Among PWID who had never been on OAT, being male (aOR=2.2; 95%CI=1.1-4.2), younger age (aOR=1.9; 95%CI=1.2-3.2), higher income (aOR=2.0; 95%CI=1.2-3.4) and previous unsuccessful attempts to enter OAT (aOR=2.3; 95%CI=1.1-4.7) were independently associated with WTP. PWID were willing to commit a large percentage of their monthly income for OAT, which, however, varied significantly based on OAT experience: current OAT: 37% of monthly income, previous OAT: 53%, and never OAT: 60% (p-value=0.0009).

CONCLUSIONS

WTP for OAT was substantial among PWID in Ukraine, supporting the implementation of self-pay or co-payment programs. Such strategies, however, must remain affordable, provide better access to OAT, and consider specific needs of PWID.

Measuring the Harm of Illicit Drug Use on Friends and Family

AIMS

This paper explores different approaches to quantify the human costs related to drug use.

DATA AND METHODS

The data come from a representative survey of 3092 respondents above the age of 18 in four Nordic capitals: Copenhagen, Helsinki, Oslo and Stockholm.

Results

The results show that in most Nordic capitals more than half of the respondents at some time have known and worried about the drug use of somebody they know personally. Moreover, while the average reported harm was about 2 on a scale from 0 to 10, a significant minority (10%) of those knowing drug users indicated that the harm was above 5.

Conclusions

Many persons have at some time personally known somebody who uses drugs. This causes significant human harm and should be included in the estimate of the social cost of illegal drugs. These results are relevant in the debate on the size of the drug problem as well as for targeting groups that experience the highest costs.

A systematic review of stated preference studies reporting public preferences for healthcare priority setting

BACKGROUND

There is current interest in incorporating weights based on public preferences for health and healthcare into priority-setting decisions.

OBJECTIVE

The aim of this systematic review was to explore the extent to which public preferences and trade-offs for priority-setting criteria have been quantified, and to describe the study contexts and preference elicitation methods employed.

METHODS

A systematic review was performed in April 2013 to identify empirical studies eliciting the stated preferences of the public for the provision of healthcare in a priority-setting context. Studies are described in terms of (i) the stated preference approaches used, (ii) the priority-setting levels and contexts, and (iii) the criteria identified as important and their relative importance.

RESULTS

Thirty-nine studies applying 40 elicitation methods reported in 41 papers met the inclusion criteria. The discrete choice experiment method was most commonly applied (n = 18, 45.0 %), but other approaches, including contingent valuation and the person trade-off, were also used. Studies prioritised health systems (n = 4, 10.2 %), policies/programmes/services/interventions (n = 16, 41.0 %), or patient groups (n = 19, 48.7 %). Studies generally confirmed the importance of a wide range of process, non-health and patient-related characteristics in priority setting in selected contexts, alongside health outcomes. However, inconsistencies were observed for the relative importance of some prioritisation criteria, suggesting context and/or elicitation approach matter.

CONCLUSIONS

Overall, findings suggest caution in directly incorporating public preferences as weights for priority setting unless the methods used to elicit the weights can be shown to be appropriate and robust in the priority-setting context.

Cost benefit analysis of two policy options for cannabis: status quo and legalisation

Aims

To date there has been limited analysis of the economic costs and benefits associated with cannabis legalisation. This study redresses this gap. A cost benefit analysis of two cannabis policy options the status quo (where cannabis use is illegal) and a legalised–regulated option was conducted.

Method

A cost benefit analysis was used to value the costs and benefits of the two policies in monetary terms. Costs and benefits of each policy option were classified into five categories (direct intervention costs, costs or cost savings to other agencies, benefits or lost benefits to the individual or the family, other impacts on third parties, and adverse or spill over events). The results are expressed as a net social benefit (NSB).

Findings

The mean NSB per annum from Monte Carlo simulations (with the 5 and 95 percentiles) for the status quo was $294.6 million AUD ($201.1 to $392.7 million) not substantially different from the $234.2 million AUD ($136.4 to $331.1 million) for the legalised–regulated model which excludes government revenue as a benefit. When government revenue is included, the NSB for legalised–regulated is higher than for status quo. Sensitivity analyses demonstrate the significant impact of educational attainment and wellbeing as drivers for the NSB result.

Conclusion

Examining the percentiles around the two policy options, there appears to be no difference between the NSB for these two policy options. Economic analyses are essential for good public policy, providing information about the extent to which one policy is substantially economically favourable over another. In cannabis policy, for these two options this does not appear to be the case.

Willingness to pay for private primary care services in Hong Kong: are elderly ready to move from the public sector?

How to provide better primary care and achieve the right level of public-private balance in doing so is at the centre of many healthcare reforms around the world. In a healthcare system like Hong Kong, where inpatient services are largely funded through general taxation and ambulatory services out of pocket, the family doctor model of primary care is underdeveloped. Since 2008, the Government has taken forward various initiatives to promote primary care and encourage more use of private services. However, little is known in Hong Kong or elsewhere about consumers' willingness to pay (WTP) for private services when care is available in the public sector. This study assessed willingness of the Hong Kong elderly to pay for specific primary care and preventive services in the private sector, through a cross-sectional in-person questionnaire survey and focus group discussions among respondents. The survey revealed that the WTP for private services in general was low among the elderly; particularly, reported WTP for chronic conditions and preventive care both fell below the current market prices. Sub-group analysis showed higher WTP among healthier and more affluent elderly. Among other things, concerns over affordability and uncertainty (of price and quality) in the private sector were associated with this low level of WTP. These results suggest that most elderly, who are heavy users of public health services but with limited income, may not use more private services without seeing significant reduction in price. Financial incentives for consumers alone may not be enough to promote primary care or public-private partnership. Public education on the value of prevention and primary care, as well as supply-side interventions should both be considered. Hong Kong's policy-making process of the initiative studied here may also provide lessons for other countries with ongoing healthcare reforms.

Assessing households' willingness to pay for an immediate pandemic influenza vaccination programme

AIMS

This study sought to contribute to the existing literature on pandemic influenza vaccination studies by providing additional evidences of households' willingness to pay (WTP) for protection against influenza during a pandemic situation from North America.

METHODS

A standard dichotomous-choice contingent valuation survey was designed and completed in a sample of 306 individuals living in the Greater Toronto Area, Ontario, Canada.

RESULTS

This study shows that, on average, households are willing to pay $417.35 for immediate pandemic influenza (H1N1) vaccination. Results show that the vaccine price, age, gender, occupation, organisation, annual family income, receiving annual flu shot, having additional insurance, having someone with a serious illness in the house, knowledge about pandemics, trusting official information on pandemics, supporting government expenditure, and rating government pandemic planning have significant effects on the decision to accept the vaccine bids.

CONCLUSIONS

The results reconfirm the findings of similar studies that influenza vaccine programmes are highly cost-effective despite the high programme cost, because people's WTP (benefits) for this programme is much higher than the actual costs. Pandemic influenza vaccination programmes should consider the demographic and economic status of the target population as such characteristics have significant impacts on the benefits that people place on such programmes.

Willingness to pay to reduce alcohol-related harm in Australian rural communities

A common metric is needed to compare the benefits of interventions to reduce alcohol misuse. Monetary value is one such metric that can be elicited using willingness to pay (WTP). This paper explores household WTP for reductions in alcohol-related harm in 20 rural Australian communities. Data were obtained from both postal and face-to-face questionnaires. The results indicate that those with friends or family drinking too much are willing to pay more to reduce alcohol-caused harm, but there was no evidence to suggest those causing and experiencing the most alcohol-caused harm (drinking at high frequency and intensity) had a higher WTP. These findings can be compared with the cost of implementing interventions to determine whether they are likely to be welfare enhancing.

Willingness-to-pay to avoid the time spent and discomfort associated with screening colonoscopy

BACKGROUND

The screening colonoscopy process requires a considerable amount of time and some discomfort for patients.

OBJECTIVE

We sought to use willingness-to-pay (WTP) to value the time required and the discomfort associated with screening colonoscopy. In addition, we aimed to explore some of the differences between and potential uses of the WTP and the human capital methods.

METHODS

Subjects completed a diary recording time and a questionnaire including WTP questions to value the time and discomfort associated with colonoscopy. We also valued the elapsed time reported in the diaries (but not the discomfort) using the human capital method.

RESULTS

110 subjects completed the study. Mean WTP to avoid the time and discomfort was $263. Human capital values for elapsed time were greater. Linear regressions showed that WTP was influenced most by the difficulty of the preparation, which added $147 to WTP (p=0.03).

CONCLUSIONS

WTP values to avoid the time and discomfort associated with the screening colonoscopy process were substantially lower than most of the human capital values for elapsed time alone. The human capital method may overestimate the value of time in situations that involve an irregular, episodic series of time intervals, such as preparation for or recovery after colonoscopy.

The cost of crime to society: new crime-specific estimates for policy and program evaluation

Estimating the cost to society of individual crimes is essential to the economic evaluation of many social programs, such as substance abuse treatment and community policing. A review of the crime-costing literature reveals multiple sources, including published articles and government reports, which collectively represent the alternative approaches for estimating the economic losses associated with criminal activity. Many of these sources are based upon data that are more than 10 years old, indicating a need for updated figures. This study presents a comprehensive methodology for calculating the cost to society of various criminal acts. Tangible and intangible losses are estimated using the most current data available. The selected approach, which incorporates both the cost-of-illness and the jury compensation methods, yields cost estimates for more than a dozen major crime categories, including several categories not found in previous studies. Updated crime cost estimates can help government agencies and other organizations execute more prudent policy evaluations, particularly benefit-cost analyses of substance abuse treatment or other interventions that reduce crime.

The cost of treating addiction from the client's perspective: results from a multi-modality application of the Client DATCAP

There is a considerable disparity between the number of individuals who need substance abuse treatment and the number who actually receive it. This is partly due to the fact that many individuals with substance use disorders do not perceive a need for formal treatment. Another contributing factor, however, is a discrepancy between the real and perceived cost of services. Although many cost evaluations of substance abuse treatment have been conducted from the treatment provider perspective, less is known about the client-specific costs of attending treatment (e.g., lost work and leisure time, transportation, out-of-pocket and in-kind payments). Concerns about financial and other barriers to participating in treatment have encouraged addiction researchers to more carefully consider these previously unmeasured costs. To address this information gap, we administered the Client Drug Abuse Treatment Cost Analysis Program (Client DATCAP) to 302 clients (representing a total of 302 outpatient and 142 inpatient treatment episodes) as part of a larger study examining the cost-effectiveness of interventions designed to improve treatment linkage and engagement in Dayton, Ohio. The value of a client's time accounted for the largest component of total cost (more than 59%). The cost per visit for outpatient clients ranged from $19 for outpatient methadone to $38 for intensive outpatient/aftercare treatment. The average cost per day of treatment for inpatient clients was $235. Policy makers and treatment providers now have a broader view of the opportunity cost of addiction treatment and can use this information to support initiatives for improved treatment access and delivery.

Willingness to pay for weight-control treatment

OBJECTIVES

To estimate willingness to pay (WTP) for alternative forms of weight-control treatment and evaluate how it varies with individual characteristics.

METHODS

Contingent valuation (CV) survey of employed females in Taiwan using double-bounded dichotomous-choice question format and telephone interview. Statistical models include an estimated correction for sample-selection bias associated with respondents' interest in weight loss.

RESULTS

Estimated WTP is strongly and positively associated with younger age, greater personal income, higher body weight, adverse personal weight perceptions, and greater peer pressure for weight control. There is a little evidence of sample-selection bias associated with the decision to lose weight. Estimated WTP for a weight-loss medicine is about US$ 12 per month, larger than estimated WTP for a low-calorie diet of about US$ 10 per month.

CONCLUSIONS

WTP for weight-control treatment among women in Taiwan is significant and related to individual characteristics such as age, income, and perceptions about current and optimal weight.

Willingness to pay for drug rehabilitation: implications for cost recovery

OBJECTIVES

This study estimates the value that clients place on methadone maintenance and how this value varies with the effectiveness of treatment and availability of case management. We provide the first estimate of the price elasticity of the demand for drug treatment.

METHODS

We interviewed 241 heroin users who had been referred to, but had not yet entered, methadone maintenance treatment in Baltimore, Maryland. We asked each subject to state a preference among three hypothetical treatment programs that varied across three domains: weekly fee paid by the client out-of-pocket ($5-$100), presence/absence of case management, and time spent heroin-free (3-24 months). Each subject was asked to complete 18 orthogonal comparisons. Subsequently each subject was asked if they likely would enroll in their preferred choice among the set of three. We computed the expected willingness to pay (WTP) as the probability of enrollment times the fee considered in each choice considered from a multivariate logistic model that controlled for product attributes. We also estimated the price elasticity of demand.

RESULTS

The median expected fee subjects were willing to pay for a program that offered 3 months of heroin-free time was $7.30 per week, rising to $17.11 per week for programs that offered 24 months of heroin-free time. The availability of case management increased median WTP by $5.64 per week. The price elasticity was -0.39 (S.E. 0.042).

CONCLUSIONS

Clients will pay more for higher rates of treatment success and for the presence of case management. Clients are willing to pay for drug treatment but the median willingness to pay falls short of the estimated program costs of $82 per week. Thus a combined approach of user fees and subsidization may be the optimal financing strategy for the drug treatment system.

Willingness to pay for drug abuse treatment: results from a contingent valuation study in Taiwan

OBJECTIVE

In this study, we attempted to describe and justify the use of a contingent valuation (CV) method to elicit the willingness to pay (WTP) for a drug abuse treatment program by the general public in Taiwan.

METHOD

In total, 1817 CV survey questionnaires were conducted through telephone interviews from randomly dialed numbers. Subjects were members of the general public aged between 20 and 65 years, with full-time jobs, and residing in the three major Taiwanese cities of Taipei, Taichung, and Kaohsiung. Respondents' WTP for drug treatment programs was elicited for two different financing mechanisms: payment through 'compulsory' payroll tax/health insurance premiums, and through 'voluntary' donations. The WTP was modeled as a function of scenarios and policies of the treatment program, respondents' socio-demographic information, and their responses to knowledge and attitudes questions.

RESULTS

The general public in Taiwan was estimated to be willing to pay between NT$81.00 and NT$95.00 per month for a drug abuse treatment program, while the benefits of drug abuse treatment were estimated to range between NT$12.8 billion and NT$15.0 billion in 2004 (US$1=NT$31.9 in 2004), which was equal to around 0.15% of Taiwan's GDP for that year. The general public in Taiwan was more willing to pay for drug abuse treatment via increases in NHI premiums than via donations. Preferences for the drug abuse treatment program were also found to be sensitive to the target treated population as well as the sequence in which the WTP questions were asked.

CONCLUSIONS

Results of this study provide policymakers with important evidence on the monetary value of a substance abuse treatment program, allocation of healthcare resources, and a possible financing mechanism of the treatment program, which may be justified by knowledge of the WTP of the general public. This study has also advanced the knowledge of the methodological issues with regard to CV questionnaire design, and it provides a base case for further studies on drug abuse in Taiwan.

How great is willingness to pay for recovery from sequelae after severe traumatic brain injury in Japan?

OBJECTIVE

To evaluate the burden on families with a family member suffering traumatic brain injury sequelae in Japan.

DESIGN

Cross-sectional study.

METHODS

Family members' burden from the sequelae of traumatic brain injury was estimated by use of willingness-to-pay models and the contingent valuation method. A national survey among 1707 members of the Japan Traumatic Brain Injury Association was conducted by postal questionnaire with open-ended questions. A total of 509 (29.8%) of the family members responded (405 men and 104 women). Mean age of patients with traumatic brain injury was 33.4 (SD 14.3) years and of responding family members 53.3 (SD 14.5) years.

RESULTS

Willingness-to-pay for the family member's recovery from sequelae of traumatic brain injury (8,694,502 Japanese yen; 79,134 US dollars/year) was similar to that reported for a family member's survival from incurable terminal disease (8,342,953 Japanese yen; 75,934 US dollars/year).

CONCLUSION

The data indicate that family members perceive the burden of a family member with traumatic brain injury sequelae as similar to what would have been caused by an incurable terminal disease.

Benefits and costs of methadone treatment: results from a lifetime simulation model

Several studies have examined the benefits and costs of drug treatment; however, they have typically focused on the benefits and costs of a single treatment episode. Although beneficial for certain analyses, the results are limited because they implicitly treat drug abuse as an acute problem that can be treated in one episode. We developed a Monte Carlo simulation model that incorporates the chronic nature of drug abuse. Our model represents the progression of individuals from the general population aged 18-60 with respect to their heroin use, treatment for heroin use, criminal behavior, employment, and health care use. We also present three model scenarios representing an increase in the probability of going to treatment, an increase in the treatment length of stay, and a scenario in which drug treatment is not available to evaluate how changes in treatment parameters affect model results. We find that the benefit-cost ratio of treatment from our lifetime model (37.72) exceeds the benefit-cost ratio from a static model (4.86). The model provides a rich characterization of the dynamics of heroin use and captures the notion of heroin use as a chronic recurring condition. Similar models can be developed for other chronic diseases, such as diabetes, mental illness, or cardiovascular disease.

Experience with family drug courts in three cities

The purpose of the study was to describe the following components of specialized Family Drug Courts: (1) children under court supervision; (2) parent(s) named in the petition; (3) services provided and court actions taken; and (4) relapse rates. Data were collected from the court records of 65 families in three courts in Florida, Kansas, and New York. Courts differed in type of clients, sanctions used, and length of time required between drug testing. Drug testing frequency varied depending on the parent's recovery and cooperation. Test results indicated a decline in drug use in the first four months and an increased risk for relapse between the 15th and 19th weeks. Specialized Family Drug Courts show promise for an improved way to address child abuse and neglect involving parental substance use. They can also provide a unique clinical training experience for health professionals.

A research agenda for economic evaluation of substance abuse services

Economic analyses of substance abuse interventions play a critical role in informing the decision makers involved in funding these programs. Despite the emergence of new and more effective interventions, the adoption of costlier services still demands justification based on economic evidence. Updated and more rigorous economic information allows patients, health care professionals, insurance companies, policymakers, and others to allocate scarce resources more efficiently. To prepare for the next wave of addiction health services research, this article presents background information on the economics of addiction health services, reviews recent empirical and methodological contributions, and provides 15 research recommendations.

Estimating rural households' willingness to pay for health insurance

In many developing countries limited health budgets are a serious problem. Innovative ways to raise funds for the provision of health services, for example, through health care insurance, have a high priority. Health care insurance for rural households shields such patients from unexpected high costs of care. However, there are questions about whether, and how much, rural households are willing to pay to purchase such insurance, as well as the factors determining willingness to pay. In recent years the Iranian government has tried to improve health and medical services to rural areas through a health insurance program. This study was conducted to estimate rural households' demand and willingness to pay for health insurance. A contingent valuation method (CVM) was applied using an iterative bidding game technique. Data has been collected from a sample of 2,139 households across the country.

The benefit of health insurance coverage of contraceptives in a population-based sample

This study estimated the value of contraceptives, through a random-digit-dialed survey of willingness to pay for health insurance coverage of contraceptives among 659 Washington State adults. People valued contraceptives at 5 times the actuarial cost; in general, women and reproductive-aged persons were willing to pay more, but low-income men highly valued contraceptives. Most respondents (85%) said that contraceptives should be covered by health insurance plans. The full benefit of contraceptives exceeds their cost.

The effects of time and money prices on treatment attendance for methadone maintenance clients

Many methadone maintenance clients are required to visit a clinic daily, so treatment attendance is essential for clients' compliance and treatment effectiveness. Using data derived from a unique survey, this study provides evidence of economic barriers to regular treatment attendance. Hypotheses tested are (1) higher personal costs reduce treatment attendance, and (2) willingness to pay (WTP) provides better time price estimates than wage rates. The findings suggest that both time and money function as rationing devices for methadone maintenance clients. The study finds WTP preferable to wage rate in measuring time price as evaluated by the effects of time price on treatment attendance.

The relative contribution of outcome domains in the total economic benefit of addiction interventions: a review of first findings

AIMS

This paper provides a focused summary of the relative contribution of addiction intervention outcomes to total economic benefit, based upon a compilation of published economic studies from the United States.

DESIGN

The relevant literature was searched extensively, and 11 economic studies were selected for review.

SETTING

The selected addiction interventions address both alcohol use/abuse and illicit drug use/abuse and represent various treatment modalities, including a brief physician intervention and long-term residential programs.

PARTICIPANTS

Study participants included community-based drug users, pregnant and/or parenting women, problem drinkers, and criminal offenders.

MEASUREMENTS

These studies estimated the economic benefits of an addiction intervention(s) in terms of one or more of the following outcome domains: criminal activity, health services utilization, employment earnings, and expenditures on illicit drugs and alcohol.

FINDINGS

The primary finding of this review was that avoided criminal activity was the greatest economic benefit of addiction interventions and contributed more, as a separate outcome domain, to the total economic benefit of addiction interventions than any other outcome domain. Reduced utilization of health care services was also a noteworthy economic benefit of addiction interventions.

CONCLUSIONS

This study provides a detailed exposition of economic benefits estimation and highlights the potential impact of individual outcomes, thus providing a useful resource for substance abuse researchers and administrators as they design and evaluate future interventions.

Measuring the value of time for methadone maintenance clients: willingness to pay, willingness to accept, and the wage rate

Three measures of the value of time - willingness to pay (WTP) for a reduction in travel time, willingness to accept (WTA) a monetary compensation to forgo it, and the wage rate - are evaluated and compared. WTP and WTA were estimated from the two-part regressions of time price, using contingent valuation methods with primary survey data. Systematic differences are found in comparisons of WTP and WTA with the wage rate.