Jytte Seested Nielsen

Scope insensitivity in contingent valuation studies of health care services: should we ask twice?

The main purpose of the present study was to test for outcome scope insensitivity. Respondents were initially asked to value one of two severe health states by way of a time-trade-off (TTO) exercise. Subsequent to the TTO exercise all respondents were asked to value an intervention, which offered a reduction in risk of falling into the health state they had evaluated. All respondents were subsequent to this initial CV exercise asked to value the same risk reduction, but in this case the outcome was death. Although our study passes the internal scope test, there is not a high degree of sensitivity to outcome. As many as 68% of respondents stated an identical maximum WTP in first and second CV valuation exercise implying that they value the interventions equally despite the fact that the health state presented in the initial CV question was deemed far better than death according to the TTO responses given by the same respondents. In contrast, the external scope test (comparison of response to initial CV across study arms) fared much better.

Does question order influence sensitivity to scope? Empirical findings from a web-based contingent valuation study

This paper examines the relationship between question order and sensitivity to scope in a large-scale web-based stated preference survey using an Internet panel. Results are presented from a contingent valuation survey in which each individual was asked to value two independent gains in life expectancy. Using split-sample data for question order we are able to study sensitivity to scope by carrying out an internal as well as an external scope test, and to examine whether question order influences sensitivity to scope. Finally, we address whether our results raise some specific concerns regarding the use of web-based surveys. Overall we find that choice of elicitation approach – in this case bottom-up versus top-down – influences the stated willingness-to-pay values leading to order effects and differences in scope sensitivity. Our findings demonstrate that elicitation approach affects the decision-making strategy, suggesting that preferences at least to some extent are reference dependent and constructed during the elicitation task. In addition, our findings indicate some relation between scope insensitivity, time spent on filling out the questionnaire and experience as an Internet panel member.

From representing views to representativeness of views: Illustrating a new (Q2S) approach in the context of health care priority setting in nine European countries

Governments across Europe are required to make decisions about how best to allocate scarce health care resources. There are legitimate arguments for eliciting societal vales in relation to health care resource allocation given the roles of the general public as payers and potential patients. However, relatively little is known about the views of the general public on general principles which could guide these decisions. In this paper we present five societal viewpoints on principles for health care resources allocation and develop a new approach, Q2S, designed to investigate the extent to which these views are held across a range of European countries. An online survey was developed, based on a previously completed study Q methodology, and delivered between November 2009 and February 2010 across nine countries to 33,515 respondents. The largest proportion of our respondents (44%), were found to most associate themselves with an egalitarian perspective. Differences in views were more strongly associated with countries than with socio-demographic characteristics. These results provide information which could be useful for decision makers in understanding the pluralistic context in which they are making health care resource allocation decisions and how different groups in society may respond to such decisions.

Risk aversion and religious behaviour: Analysis using a sample of Danish twins

&NA; Economics offers an analytical framework to consider human behaviour including religious behaviour. Within the realm of Expected Utility Theory, religious belief and activity could be interpreted as an insurance both for current life events and for afterlife rewards. Based on that framework, we would expect that risk averse individuals would demand a more generous protection plan which they may do by devoting more effort and resources into religious activities such as church attendance and prayer, which seems to be in accordance with previous empirical results. However, a general concern regards the problems of spurious correlations due to underlying omitted or unobservable characteristics shaping both religious activities and risk attitudes. This paper examines empirically the demand for religion by analysing the association between risk attitudes on the one hand, and church attandance and prayer frequency on the other controlling for unobservable variables using survey data of Danish same‐sex twin pairs. We verify the correlation between risk preferences and religion found previously by carrying out cross‐sectional analyses. We also show that the association between risk attitudes and religious behaviour is driven by the subgroup of individuals who believe in an afterlife. In addition, when re‐analysing our results using panel data analyses which cancel out shared factors among twin pairs, we find that the correlation found between risk aversion and religious behaviour is no longer significant indicating that other factors might explain differences in religious behaviour. Caution is needed in the interpretation of our results as the insignificant association between risk aversion and religious behaviour in the panel data analyses potentially might be due to measurement error causing attenuation bias or lack of variation within twin pairs rather than the actual absence of an association.

The Value of Mortality Risk Reductions. Pure Altruism - A Confounder?

This paper examines public valuations of mortality risk reductions. We set up a theoretical framework that allows for altruistic preferences, and subsequently test theoretical predictions through the design of a discrete choice experiment. By varying the tax scenario (uniform versus individual tax), the experimental design allows us to verify whether pure altruistic preferences are present and the underlying causes. We find evidence of negative pure altruism. Under a coercive uniform tax system respondents lower their willingness to pay possibly to ensure that they are not forcing others to pay at a level that corresponds to their own – higher – valuations. This hypothesis is supported by the observation that respondents perceive other individuals’ valuations to be lower than their own. Our results suggest that public valuations of mortality risk reductions may underestimate the true societal value because respondents are considering other individuals’ welfare, and wrongfully perceive other people’s valuations to be low.

Valuation of morbidity and mortality risk reductions. Does context matter

The main research purpose of the present study was to test for any differences in the valuation of morbidity and mortality risk reductions across two contexts; traffic and health. A contingent valuation study on preferences for morbidity and mortality risk was carried out in Denmark in 2007. Respondents were randomised into two different arms: one arm in which the valuation took place in the context of health and another arm in which the context was traffic. In both contexts, the inferior health state was described by way of the standardized EQ-5D descriptive system. We obtained a total sample of 520 respondents from an online database. In the present study we found clear evidence of a context effect on expressed valuations of identical risk reductions. This was true irrespective of whether the adverse outcome in question was death or inferior health. This result suggests that interventions targeting risks of death or risks of ill health should not necessarily be valued equally across sectors. From a welfare economic perspective, the use of the same estimates across contexts - and especially across sectors - could be misleading and in worst case lead to inefficient resource allocations.