Emmanouil Mentzakis

Using discrete choice experiments to value informal care tasks: exploring preference heterogeneity.

While informal care is a significant part of non-market economic activity, its value is rarely acknowledged, perhaps reflecting a lack of market data. Traditional methods to value such care include opportunity and replacement cost. This study is the first to employ the discrete choice experiment methodology to value informal care tasks. A monetary value is estimated for three tasks (personal care, supervising and household tasks). The relationship between time spent on formal and informal care is also modelled and preference heterogeneity investigated using the Latent Class Model. Complementarity between supervising tasks and formal care is observed. Monetary compensation is important, with willingness to accept per hour values ranging from £0.38 to £0.83 for personal care, £0.75 for supervising and £0.31 to £0.6 for household tasks. Heterogeneity in preferences is observed, with monetary compensation being important for younger people, but insignificant for older individuals. Such heterogeneity is important at the policy level. Values are lower than those generated by opportunity cost and replacement cost methods, perhaps because of the limited ability of revealed preference methods to capture broader aspect of utility. Differences with contingent valuation methods are also observed, suggesting future research should investigate the external validity of the different methods.

A discrete choice experiment investigating preferences for funding drugs used to treat orphan diseases: an exploratory study

Policy debate about funding criteria for drugs used to treat rare, orphan diseases is gaining prominence. This study presents evidence from a discrete choice experiment using a convenience sample of university students to investigate individual preferences regarding public funding for drugs used to treat rare diseases and common diseases. This pilot study finds that: other things equal, the respondents do not prefer to have the government spend more for drugs used to treat rare diseases; that respondents are not willing to pay more per life year gained for a rare disease than a common disease; and that respondents weigh relevant attributes of the coverage decisions (e.g. costs, disease severity and treatment effectiveness) similarly for both rare and common diseases. The results confirm the importance of severity and treatment effectiveness in preferences for public funding. Although this is the first study of its kind, the results send a cautionary message regarding the special treatment of orphan drugs in coverage decision-making.

Do Canadian Researchers and the Lay Public Prioritize Biomedical Research Outcomes Equally? A Choice Experiment

Purpose To quantify and compare the preferences of researchers and laypeople in Canada regarding the outcomes of basic biomedical research. Method In autumn 2010, the authors conducted a cross-sectional, national survey of basic biomedical researchers funded by Canada’s national health research agency and a representative sample of Canadian citizens to assess preferences for research outcomes across five attributes using a discrete choice experiment. Attributes included advancing scientific knowledge (assessed by published papers); building research capacity (assessed by trainees); informing decisions in the health products industry (assessed by patents); targeting economic, health, or scientific priorities; and cost. The authors reduced a fractional factorial design (18 pairwise choices plus an opt-out option) to three blocks of six. They also computed part worth utilities, differences in predicted probabilities, and willingness-to-pay values using nested logit models. Results Of 3,260 potential researchers, 1,749 (53.65% response rate) completed the questionnaire, along with 1,002 citizens. Researchers and citizens prioritized high-quality scientific outcomes (papers, trainees) over other attributes. Both groups disvalued research targeted at economic priorities relative to health priorities. Researchers granted a premium to proposals targeting scientific priorities. Conclusions Citizens and researchers fundamentally prioritized the same outcomes for basic biomedical research. Notably, they prioritized traditional scientific outcomes and disvalued the pursuit of economic returns. These findings have implications for how academic medicine assigns incentives and value to basic health research and how biomedical researchers and the public may jointly contribute to setting the future research agenda.

Detecting and Characterizing Eating-Disorder Communities on Social Media

Eating disorders are complex mental disorders and responsible for the highest mortality rate among mental illnesses. Recent studies reveal that user-generated content on social media provides useful information in understanding these disorders. Most previous studies focus on studying communities of people who discuss eating disorders on social media, while few studies have explored community structures and interactions among individuals who suffer from this disease over social media. In this paper, we first develop a snowball sampling method to automatically gather individuals who self-identify as eating disordered in their profile descriptions, as well as their social network connections with one another on Twitter. Then, we verify the effectiveness of our sampling method by: 1. quantifying differences between the sampled eating disordered users and two sets of reference data collected for non-disordered users in social status, behavioral patterns and psychometric properties; 2. building predictive models to classify eating disordered and non-disordered users. Finally, leveraging the data of social connections between eating disordered individuals on Twitter, we present the first homophily study among eating-disorder communities on social media. Our findings shed new light on how an eating-disorder community develops on social media.

Estimating the causal effect of alcohol consumption on well-being for a cross-section of 9 former Soviet Union countries.

While the adverse health and economic consequences attributable to alcohol consumption are widely acknowledged, its impact on psychological wellbeing is less well understood. This is to a large extent due to the challenge of establishing causal effects of alcohol consumption when using standard single-equation econometric analyses. Using a unique dataset collected in 2010/11 of 18,000 individuals and also community characteristics from nine countries of the former Soviet Union, a region with a major burden of alcohol related ill health, we address this problem by employing an instrumental variable approach to identify any causal effects of alcohol consumption on mental well-being. The availability of 24-h alcohol sales outlets in the neighbourhood of the individuals is used as an instrument, based on theoretical reasoning and statistical testing of its validity. We find that increased alcohol consumption decreases well-being and that ignoring endogeneity leads to underestimation of this effect. This finding adds a further and previously under-appreciated dimension to the expected benefits that could be achieved with more effective alcohol policy in this region.

Effects of air pollution and meteorological parameters on human health in the city of Athens, Greece

The impact of air pollution (CO, NO, NO2, SO2, O3) and meteorological parameters (air temperature, humidity and atmospheric pressure) on three indicators of human morbidity (circulatory, respiratory and skin diseases) is quantified, while the sensitivity of the results to different model specifications is tested. Findings indicate that higher SO2 and CO levels significantly increase circulatory and skin diseases, respectively, while higher NO and O3 concentrations increase respiratory diseases. Air temperature is significantly associated with all human health indicators. This work highlights the need for lower air pollution standards for the city of Athens and a wider climate change policy.

Equity and efficiency preferences of health policy makers in China--a stated preference analysis.

BACKGROUND Macroeconomic growth in China enables significant progress in health care and public health. It faces difficult choices regarding access, quality and affordability, while dealing with the increasing burden of chronic diseases. Policymakers are pressured to make complex decisions while implementing health strategies. This study shows how this process could be structured and reports the specific equity and efficiency preferences among Chinese policymakers. METHODS In total, 78 regional, provincial and national level policymakers with considerable experience participated in a discrete choice experiment, weighting the relative importance of six policy attributes describing equity and efficiency. Results from a conditional logistic model are presented for the six criteria, measuring the associated weights. Observed and unobserved heterogeneities were incorporated and tested in the model. Findings are used to give an example of ranking health interventions in relation to the present disease burden in China. RESULTS In general, respondents showed strong preference for efficiency criteria i.e. total beneficiaries and cost-effectiveness as the most important attributes in decision making over equity criteria. Hence, priority interventions would be those conditions that are most prevalent in the country and cost least per health gain. CONCLUSION Although efficiency criteria override equity ones, major health threats in China would be targeted. Multicriteria decision analysis makes explicit important trade-offs between efficiency and equity, leading to explicit, transparent and rational policy making.

External Validity of Contingent Valuation: Comparing Hypothetical and Actual Payments

Whilst contingent valuation is increasingly used in economics to value benefits, questions remain concerning its external validity that is do hypothetical responses match actual responses? We present results from the first within sample field test. Whilst Hypothetical No is always an Actual No, Hypothetical Yes exceed Actual Yes responses. A constant rate of response reversals across bids/prices could suggest theoretically consistent option value responses. Certainty calibrations (verbal and numerical response scales) minimise hypothetical-actual discrepancies offering a useful solution. Helping respondents resolve uncertainty may reduce the discrepancy between hypothetical and actual payments and thus lead to more accurate policy recommendations. Copyright

Efficiency and equity considerations in the preferences of health policy-makers in Israel

BackgroundThere is a traditional tension in public policy between the maximization of welfare from given resources (efficiency) and considerations related to the distribution of welfare among the population and to social justice (equity). The aim of this paper is to measure the relative weights of the efficiency- and equity-enhancing criteria in the preferences of health policy-makers in Israel, and to compare the Israeli results with those of other countries.MethodsWe used the criteria of efficiency and equity which were adopted in a previous international study, adapted to Israel. The equity criteria, as defined in the international study, are: severity of the disease, age (young vs. elderly), and the extent to which the poor are subsidized. Efficiency is represented by the criteria: the potential number of beneficiaries, the extent of the health benefits to the patient, and the results of economic assessments (cost per QALY gained). We contacted 147 policy-makers, 65 of whom completed the survey (a response rate of 44%). Using Discrete Choice Experiment (DCE) methodology by 1000Minds software, we estimated the relative weights of these seven criteria, and predicted the desirability of technologies characterized by profiles of the criteria.ResultsThe overall weight attached to the four efficiency criteria was 46% and that of the three equity criteria was 54%. The most important criteria were “financing of the technology is required so that the poor will be able to receive it” and the level of individual benefit. “The technology is intended to be used by the elderly” criterion appeared as the least important, taking the seventh place. Policy-makers who had experience as members of the Basket Committee appear to prefer efficiency criteria more than those who had never participated in the Basket Committee deliberations. While the efficiency consideration gained preference in most countries studied, Israel is unique in its balance between the weights attached to equity and efficiency considerations by health policy-makers.DiscussionThe study explored the trade-off between efficiency and equity considerations in the preferences of health policy-makers in Israel. The way these declarative preferences have been expressed in actual policy decisions remains to be explored.

Do political factors matter in explaining under- and overweight outcomes in developing countries?

Highlights • We study the role played by political factors in shaping the BMI distribution.• We allow for differing covariate effects across the BMI distribution.• We allow for heteroskedasticity across macro regions.• Democratic systems reduce under-weight, but increase overweight/obesity.• Effective political competition reduces both under-weight and obesity.