Measuring effects of Agri-Health Interventions: A role for Contingent Valuation and Discrete Choice Experiments?

Transcription

1 Measuring effects of Agri-Health Interventions: A role for Contingent Valuation and Discrete Choice Experiments? Professor Mandy Ryan Health Economics Research Unit University of Aberdeen Scotland

2 Valuing benefits: a (health) economic Opportunity cost! approach Revealed Preference methods Hedonic pricing Travel cost methods Value of risky jobs Stated preference methods Quality Adjusted Life Years (QALYs) Contingent valuation (willingness to pay in a hypothetical context) Discrete Choice Experiments

3 Valuation in Health Economics Pre monetary measure of value Human capital approach, Willingness to pay 1970s - cost per some clinical measure of outcome (cost per life year) 1980s - Quality Adjusted Life Years (QALYs) focus on health outcomes National Institute for Health and Clinical Excellence (NICE) 1990s Academic community valued broader measures of wellbeing/utility Contingent valuation/willingness to Pay Discrete Choice Experiments 2000 forward QALYs dominate at policy level (NICE) Recognition broader measure of value (academia, policy documents, funding bodies)

4 Contingent Valuation/Willingness to Pay Based on the premise that the maximum amount of money an individuals is willing to pay for a commodity is an indication of the value to them of that commodity

5 Using WTP surveys/contingent Valuation WTP surveys present individuals with descriptions of what is being valued. Respondents asked how much money they would be prepared to pay Reminded of opportunity cost! Widely used in a number of areas

6 Example of an open ended WTP question - Reducing maternal and new born deaths (Ghana) Imagine that you are asked to contribute towards funding a service improvement that would reduce the number of maternal deaths in Greater Accra to 25 per month and reduce the number of newborn infant deaths to 180 per month? Number of maternal deaths in the region per month CURRENT SITUATION SERVICE IMPROVEMENT (15 lives saved) Number of newborn infant deaths in the region per month (120 lives saved) a) How much would you be willing to pay for the new service improvement: And b) How often would you be willing to make this contribution (e.g. once per month; once per year)?

7 7 Valuing Reductions in Maternal Mortality - Example of a bidding game (Burkina Faso) Let s start with a sum of 5000 CFA. B1 Would you be prepared to pay 5000 CFA? Yes (Go to B2) No (Go to B6) B2 Would you pay 5500? Yes (Go to B3) No (Stop) B3 Would you pay 6000? Yes (Go to B4) No (Stop) B4 Would you pay 6500? Yes (Go to B5) No (Stop) B5 Would you pay 7000? Yes ASK: What is the most you d be willing to pay?. No (Stop)

8 Contingent Valuation in Agricultural Economics... Willingness to pay for food safety Willingness to pay for water safety Willingness to pay to increase macro and micro nutrients 35% child deaths 11% global disease burden

9 Discrete Choice Experiments (DCEs) Attribute based measure of value (can break value down into attributes) Relative importance of attributes Marginal Rates of Substitution E.g. Willingness to pay (WTP) for an attribute» WTP for alternative profiles Willingness to pay (cost-benefit analysis) Probability of take-up/purchasing/demanding Incentives and economic levers

10 Choosing an Airline - Attributes Check-in service Ticket price Entertainment Food and drink Legroom Reclining chair

11 Choosing Partner - Attributes Choices described by attributes & levels e.g. choosing a life partner Body type Hair Eye colour Hobbies & interests Personality Trade-offs!

12 Choosing lifestyle intervention (UK) Lifestyle What the programme contains Weight change in 2 years Short term goals Improvement in type II diabetes Improvement in blood pressure Economic Incentives Lifestyle A Healthy eating with support for management of weight changes Stay the same Feeling better No reduction Small reduction Lifestyle B Physical activity Lose half a stone Looking better and feeling better Small reduction Moderate reduction Time per day 30 min/day 120 min/day Costs per week 10 1 Which option would you choose? Choose Lifestyle A Choose Lifestyle B Current Lifestyle (tick one box only)

13 Reducing maternal and new born deaths (Ghana) CURRENT SITUATION SERVICE IMPROVEMENT 1 SERVICE IMPROVEMENT 2 Number of maternal deaths in the region per month (5 lives saved) 25 (15 lives saved) Number of newborn infant deaths in the region per month (80 lives saved) 260 (40 lives saved) Additional cost to you per month No additional cost 2 Cedi 20 Cedi Which option would you choose?

14 Preferences for health system changes in South Africa The staff at the clinic/hospital are kind and treat me with respect. The staff at the clinic/hospital do not examine me. The staff at the clinic/hospital do not explain what is wrong with me or what I need to do to get better.

15 When I go to the clinic/hospital, I get the medicine I need. When I go to the clinic/hospital, I first see a nurse who is trained to treat most illnesses and only see a doctor if the nurse cannot treat my illness. I spend a whole day in the clinic/hospital before I go home. Transport to and from the clinic/hospital costs about R5.

16 Would you use this facility? Yes, I would use this facility. 1 No, I would not use this facility. 0

17 Discrete choice experiments in Agricultural Economics... Importance of food safety vis-a-vis other attributes in provision of food (appearance, convenience, nutrition value, ethics of production) Change incentives embedded in agricultural policies to encourage farmers to produce more nutritious food Economic levers to change lifestyles effects of fat taxes and thin subsidies where over nutrition is a problem

18 Measuring effects of Agri-Health Interventions: A role for Contingent Valuation and Discrete Choice Experiments?