母婴保健保偿制项目供方提供意愿分析

为了解乡镇卫生和计生服务机构人员对母婴保健保偿制项目的供给意愿,本文用支付卡的形式对其进行了调查,结果表明乡卫生院和乡计生站都愿意提供保偿服务,其中住院分娩的供给意愿最大,平均为201.18元,其次是产前检查,平均为3.23元。另外,卫生服务提供者愿意提供包括较多服务项目的大的服务包,对包括所有服务项目在内的最大的服务包的供给意愿最大,平均为246元。     

母婴保健保偿制政策分析结果

本文利用母婴保健保偿制政策分析理论模型从供需双方对保偿制进行了系统分析，结果表明：实行以乡卫生院为主体的以大服务包为主的保偿制是可行的，也是受欢迎的，预付金额宜在230到262元之间。     

母婴保健保偿制评估研究总结与建议

１　研究目的及亚课题本课题第一阶段的主要研究目的是对母婴保健保偿制的运作结果进行评价。主要从服务数量、质量、健康产出、经济负担４方面比较分析了参加保偿制与未参加保偿制人群之间的异同,说明参加保偿制者能够接受数量较多及质量较高的保健服务,获得较好的健康产出以及较轻的经济负担。然后仍从这四个方面比较分析参加乡镇卫生院保偿制者与参加乡镇计划生育站保偿制者之间的差异,说明参加何种保偿制为优。２　主要研究发现本次研究共调查了４２７１户有０～１岁孩子的家庭,其中有２０５１户参加了母子保健保偿,２２２０户没有…     

母婴保健保偿制成本测量方法初探

根据母婴保健保偿制的运作特点,本文提出了保偿制项目的成本测量与分析方法。此方法也同样适用于其他类似项目的成本分析工作,具有简单易行,操作性强的特点。     

母婴保健保偿制项目需方付意原分析

居民的支付意愿如何是影响母婴保健保偿制能滞顺利实施的关键性问题。用支付卡形式对4190名妇女进行的调查结果表明需方愿意参加保偿制,绝大多数妇女选择接受产前检查和住院分娩服务,而且偏好大的服务包,40.76%的被调查者选择了包括所有服务项目在内的最大的服务包,其支付意愿为262.34元。     

母婴保健保偿制项目的成本分析

本文对山东省10个乡卫生和8个乡计划生育服务站母婴保健保偿制项目的运作情况进行了调查分析，并比较了两类机构的经济效益。结果表明：实行母婴保健保偿制的乡卫生院和乡计生站的平均成本均比未实行保偿制的同类机构低，前者低8.24元，后者低11.59元，同时实行保偿制乡卫生院的平均成本比实行保偿制的乡计生站的平均成本低8.10元。根据研究结果认为以乡卫生院为基础的母婴保健保偿制是最优的提供者，建议进行母婴保健保偿制机构改革和/或两类服务机构合并试点。     

母婴保健保偿制对农村孕产妇健康状况的影响

孕产妇的健康产出是指妇女从怀孕到分娩这段时间内,通过产前、产时及产后保健等所获得的孕妇和胎儿的健康改善。这些指标包括产前发病率、产后发病率、新生儿健康状况、分娩时的平产率等。许多资料报道［１,２］：在实行妇幼保健保偿的地区,其健康产出比较高。我们在研究了不同妇幼保健保偿制度下孕产妇对卫生服务利用的基础上,进一步研究了其健康改善的结果。１　资料来源与方法同《母婴保健保偿制评估背景、问题及研究框架》一文。调查的主要内容有孕产妇孕产期患病情况,分娩的情况,新生儿健康状况等。２　结果与分析我们通过测量孕…     

实施保健保偿制 提高母婴健康水平

霍山县地处大别山区,经济条件比较落后,１９９０－１９９５年接受了联合国“二会”援助的《加强中国基层妇幼卫生／计划生育服务》合作项目,通过６年的实施,健全了三级保健网络,提高了保健队伍的整体素质,调整完善了各级保健机构,配备了所需的基本医疗器械和交通工...     

母婴保健保偿制几种形式的评价

本文对当前存在的几种母婴保健保偿制形式予以大体归类,分析其优劣,探讨其前景及适合的地区,认为各种形式的保偿制在现阶段都有一定的应用价值;同时还认为无论实行何种形式的保偿制,都必须加强管理,使之收到更好的效益。     

母婴保健保偿制评价研究——背景,问题及研究框架

１　背景根据１９９０年全国人口普查的基本统计，中国有１１３亿人口，其中１５～４９岁的育龄妇女和７岁以下的儿童占４１％。同人群相比，妇女和儿童属于脆弱人群。而且由于社会、经济文化等原因，他们对保健服务的可及性较差。新中国成立以后，妇幼保健服务得到了政府的极大重视，获得了迅速发展。但是长期以来妇幼保健服务所面临的一个严峻的挑战就是政府投资不足，不能完全补偿保健服务所需经费。随着８０年代初期市场经济体制改革的进行，妇幼保健服务也相应地发生了变革。一种新形的有偿服务的保健服务形式——妇幼保健保偿制应孕…     

Differential willingness of household heads to pay community-based health insurance premia for themselves and other household members

OBJECTIVE: This study compares household heads' willingness-to-pay (WTP) for community-based health insurance (CBI) for themselves with their WTP for other household members, in order to provide information for policy makers on setting the premium and choosing the enrollment unit. METHOD: A random sample of 698 heads of households was interviewed in the northwest of Burkina Faso and a bidding game approach was used to elicit WTP. Factors associated with differences in WTP were identified, including characteristics of the household head and of the household. RESULTS: Mean WTP by the heads of households for insurance for themselves (3575 CFA) was twice their mean WTP per capita for the household as a whole (1759 CFA). The old have a lower WTP than the young, females have lower WTP than males, the poor have a lower WTP than the rich, and that those with less schooling have a lower WTP than those with more years of schooling. CONCLUSION: The differences in household heads' WTP for insurance for themselves and their WTP to insure their households as a whole need to be considered when setting the insurance premium. WTP information can assist decision makers with the complex problem of choosing the enrollment unit and setting the premium.     

The impact of information on non-health attributes on willingness to pay for multiple health care programmes

Despite the acceptance that health gain is the most important attribute of health care, other aspects of health care may affect utility. The aim of this paper is to report an experiment to test the impact of providing different levels of information in the context of the EuroWill study, a joint contingent valuation (CV) of multiple health programmes. Three hundred and three respondents were simultaneously asked for their willingness-to-pay (WTP) for three health care programmes: more heart operations, a new breast cancer treatment and a helicopter ambulance service. To test for the impact of variation in information, three versions of one of the programmes (heart) were provided. Results show that WTP for all three programmes tended to be significantly higher for respondents who were provided additional positive information about the heart programme. Our results show that CV of health care programmes, which only take into account medical outcomes, may lead to the value of such programmes not being adequately estimated, and that the impact of information may even be more decisive in the context of joint evaluation of multiple, rather than single, programmes.     

Eliciting several willingness to pay in a single contingent valuation survey: application to health care

The usual implementation of contingent valuation (CV), in the context of priorities setting for allocation of public funds in health care, is to develop as many surveys as there are programmes, i.e. to perform separate evaluations (SE). In the EuroWill project, three health programmes (for heart disease, breast cancer and a service of helicopter ambulance) were however simultaneously evaluated, i.e. a joint evaluation (JE) was performed. The paper examines the issue of the econometric techniques that should be used to estimate WTP values obtained in the context of JE by comparing the application of independent OLS regressions for each programme versus simultaneous estimations using seemingly unrelated regressions (SUR) on data of the French EuroWill survey. It shows that separate estimations may lead to misspecifications because they cannot take into account that JE exogenously provides a reference structure to the respondent which affects the estimates of WTP for each programme. Therefore, the potential advantage of JE versus SE as an elicitation technique in CV studies applied to health care (to better control the referents used by respondents for evaluating different programmes) only holds if simultaneous rather than independent techniques are used in the estimation of WTPs.     

People's willingness to pay for health insurance in rural Vietnam

Background

The inequity caused by health financing in Vietnam, which mainly relies on out-of-pocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.

Methods

Using the Epidemiological Field Laboratory for Health Systems Research in the Bavi district (FilaBavi), 2070 households were randomly selected for the study. Existing FilaBavi interviewers were trained especially for this study. The interview questionnaire was developed through a pilot study followed by focus group discussions among interviewers. Determinants of households' willingness to pay were studied through interval regression by which problems such as zero answers, skewness, outliers and the heaping effect may be solved.

Results

Households' average willingness to pay (WTP) is higher than their costs for public health care and self-treatment. For 70–80% of the respondents, average WTP is also sufficient to pay the lower range of premiums in existing health insurance programmes. However, the average WTP would only be sufficient to finance about half of total household public, as well as private, health care costs. Variables that reflect income, health care need, age and educational level were significant determinants of households' willingness to pay. Contrary to expectations, age was negatively related to willingness to pay.

Conclusion

Since WTP is sufficient to cover household costs for public health care, it depends to what extent households would substitute private for public care and increase utilization as to whether WTP would also be sufficient enough to finance health insurance. This study highlights potential for public information schemes that may change the negative attitude towards health insurance, which this study has uncovered. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among the old and those with relatively low education.     

Hypothetical versus real willingness to pay in the health care sector: results from a field experiment

We conducted a field experiment comparing hypothetical and real purchase decisions for a pharmacist provided asthma management program among 172 subjects with asthma. Subjects received either a dichotomous choice contingent valuation question or were given the opportunity to actually enroll in the program. Three different prices were used: US$ 15, 40, and 80. In the hypothetical group, 38% of subjects said that they would purchase the good at the stated price, but only 12% of subjects in the real group purchased the good (p = 0.000). We cannot, however, reject the null hypothesis that "definitely sure" hypothetical yes responses, as identified in a follow-up question, correspond to real yes responses. We conclude that the dichotomous choice contingent valuation method overestimates willingness to pay, but that it may be possible to correct for this overestimation by sorting out "definitely sure" yes responses.     

Valuing health care using willingness to pay: a comparison of the payment card and dichotomous choice methods

This paper compares willingness to pay (WTP) estimates generated from the dichotomous choice (DC) and payment card (PC) approaches. In a split-sample WTP experiment concerned with allocating scarce health care resources across three health care interventions, the DC approach is shown consistently to generate larger welfare estimates than the PC. Observed difference between PC and DC experiments cannot be explained by the inclusion of non-demanders or methods of statistical analysis but may be partly explained by "yea-saying". No evidence of range bias or mid-point bias was found with PC responses. Data were also collected on respondents' ordinal rankings of the three interventions and person-trade-offs (PTOs). Neither of these approaches converged with WTP. Future work must address the decision heuristics individuals employ when responding to valuation experiments.     

The reliability of willingness to pay for changes in health status

One of the most common means to test for the temporal reliability of willingness-to-pay (WTP) values is the 'test-retest' method. However, few such tests have been conducted in healthcare, and the few that are focus on specific patient or professional groups, limiting their generalisability. In this article, a test-retest analysis of WTP for changes in health status from a general population sample found good reliability overall, with the level of reliability increasing with the overall amount of WTP and/or level of WTP as a proportion of income. The possible implications for the design and use of WTP studies in healthcare are outlined.