Verity Watson

Comparing welfare estimates from payment card contingent valuation and discrete choice experiments.

This study presents the first comparison of willingness to pay estimates derived from the payment card (PC) contingent valuation and discrete choice experiment (DCE) methods. A within-sample experiment was used to elicit womens preferences for Chlamydia screening. The willingness to pay estimate derived from the DCE was larger than that derived from the PC. To investigate why the willingness to pay estimates were different, a range of validity tests were conducted. Both methods produced theoretically valid results, and there was no difference in the reported difficulty of completing the tasks. Evidence of a prominence effect was found in the PC responses. Responses to the DCE satisfied tests of non-satiation. Responses to both methods were compared with revealed preference data. There were significant differences between stated screening intention in both methods and actual screening uptake. Future work should address the external validity of stated preference methods.

Models of intrapartum care and women’s trade‐offs in remote and rural Scotland: a mixed‐methods study

Objective  To explore women’s preferences for, and trade‐offs between, key attributes of intrapartum care models.

“Choice” and place of delivery: a qualitative study of women in remote and rural Scotland

Objective: To explore women’s perceptions of “choice” of place of delivery in remote and rural areas where different models of maternity services are available. Setting and methods: Remote and rural areas of the North of Scotland. A qualitative study design involved focus groups with women who had recent experience of maternity services. Results: Women had varying experiences and perceptions of choice regarding place of delivery. Most women had, or perceived they had, no choice, though some felt they had a genuine choice. When comparing different places of birth, women based their decisions primarily on their perceptions of safety. Consultant-led care was associated with covering every eventuality, while midwife-led care was associated with greater quality in terms of psycho-social support. Women engaged differently in the choice process, ranging from “acceptors” to “active choosers.” The presentation of choice by health professionals, pregnancy complications, geographical accessibility and the implications of alternative places of delivery in terms of demands on social networks were also influential in “choice.” Conclusions: Provision of different models of maternity services may not be sufficient to convince women they have “choice.” The paper raises fundamental questions about the meaning of “choice” within current policy developments and calls for a more critical approach to the use of choice as a service development and analytical concept.

Methodological issues in the monetary valuation of benefits in healthcare

Economic evaluation is concerned with comparing the costs and benefits of competing healthcare interventions in order to efficiently allocate resources. Whilst valuing costs is important, the valuation of benefits represents one of the greatest challenges facing health economists. This review considers the different techniques available for the valuation of healthcare benefits in monetary terms, and more specifically the contingent valuation method and discrete choice experiments. This review identifies some of the key issues and debates that have been published in the literature concerning the application of the techniques to healthcare and highlights important areas for future research.

Utilisation of eye-care services: The effect of Scotland's free eye examination policy

PURPOSE To examine how the introduction of free eye examinations in Scotland affected peoples use of eye care services. Particularly, to assess if more people are now having their eyes examined regularly, and whether there are differences in the way people responded to the policy across socio-economic groups. METHODS Using the British Household Panel Survey, eye test uptake and frequency in Scotland is compared to the rest of the UK pre and post policy. Propensity to have eye tests and responsiveness to the policy is compared across socio-economic groups. In addition, using data available from a chain of private ophthalmic opticians, clinical characteristics of eye examination patients are compared pre- and post-policy. RESULTS There is evidence that suggests that people responded positively to the policy. In particular, a higher percentage of people in Scotland have their eyes tested after the free eye care policy was introduced. Interestingly, the response to the policy varies between the different socio-economic groups. For the highest earners and most educated groups, the proportion of people having an eye test increased more than for those groups with lower income or lower education. CONCLUSIONS Although the policy succeeded in getting more people to have their eyes tested, the socio-economic differences observed suggest that the policy has not reached the more vulnerable segments in society to the same extent, in particular, those with low education and low income. As a result, eye care services utilisation inequalities have widened in Scotland after the free eye care policy was introduced.

Does one size fit all? Investigating heterogeneity in men's preferences for benign prostatic hyperplasia treatment using mixed logit analysis.

In this study, the authors demonstrate how mixed logit analysis of discrete choice experiment (DCE) data can provide information about unobserved preference heterogeneity. Their application investigates unobserved heterogeneity in men’s preferences for benign prostatic hyperplasia (BPH) treatment. They use a DCE to elicit preferences for seven characteristics of BPH treatment: time to symptom improvement, sexual and nonsexual treatment side effects, risks of acute urinary retention and surgery, cost of treatment, and reduction in prostate size. They investigate the importance of these characteristics and the trade-offs men are willing to make between them. Preferences are elicited from a sample of 100 men attending an outpatient clinic in Ireland. The authors find all treatment characteristics are significant determinants of treatment choice. There is significant preference heterogeneity in the population for four treatment characteristics: time to symptom improvement, treatment reducing prostate size, risk of surgery, and sexual side effects. The importance of preference heterogeneity at the policy level within the context of shared decision making is discussed.

Valuing Experience Factors in the Provision of Chlamydia Screening: An Application to Women Attending the Family Planning Clinic

OBJECTIVE To examine womens preferences for characteristics of chlamydia screening. Chlamydia trachomatis is the most common curable sexually transmitted disease. To design effective screening programs, it is important to fully capture the benefits of screening to patients. Thus, the value of experience factors must be considered alongside health outcomes. METHODS A self-complete discrete choice experiment questionnaire was administered to women attending a family planning clinic. Chlamydia screening was described by five characteristics: location of screening; type of screening test; cost of screening test; risk of developing pelvic inflammatory disease if chlamydia is untreated; and support provided when receiving results. RESULTS One hundred twenty-six women completed the questionnaire. Respondents valued characteristics of the care experience. Screening was valued at 15 pound; less invasive screening tests increase willingness to pay by 7 pound, and more invasive tests reduce willingness to pay by 3.50 pound. The most preferred screening location was the family planning clinic, valued at 5 pound. The support of a trained health-care professional when receiving results was valued at 4 pound. Respondents under 25 years and those in a casual relationship were less likely to be screened. CONCLUSIONS Women valued experience factors in the provision of chlamydia screening. To correctly value these screening programs and to predict uptake, cost-effectiveness studies should take such values into account. Failure to do this may result in incorrect policy recommendations.

Is it all about money? An examination of the motives behind moonlighting

Multiple-job holding is an important labour market phenomenon. In this article, we examine individuals’ motives for multiple-job holding. Specifically, we estimate an empirical model of the motivation for moonlighting assuming that individuals hold a second job for either financial or for nonpecuniary motives. Our results contribute to a better understanding of multiple-job holding. We find that multiple-job holding is used by individuals as a way to deal with the financial difficulties or the increased financial commitments in their household. Individuals are more likely to moonlight for money in the early stages of their adult life. Finally, individuals with more labour market experience are more likely to moonlight for pecuniary than nonpecuniary reasons.

Practical Issues in Conducting a Discrete Choice Experiment

This chapter walks the reader through the stages of a discrete choice experiment (DCE) application drawing on concepts introduced in Chapters 1 and 2. A case study eliciting women’s preferences for prenatal screening is used to illustrate the points (Ryan et al., 2005). It should be noted that this data was collected several years ago, and therefore adopted old methods of experimental design. The sample size is also small.We have chosen it because it demonstrates nicely the many potential uses of a DCE, it addressed a policy-relevant question at the time, and it represents one of the few studies in health economics where the scientists (geneticists) worked with the evaluators (economists) and implementers (obstetricians) to look at development, evaluation and implementation of prenatal screening programmes.

A Generation of Childless Women: Lessons from the United States

BACKGROUND Childlessness is a major public health concern in the United States, particularly among educated adults. Among women who turned 45 in 2006, one fifth had no children. We examine the likelihood that a childless woman wants a baby sometime in the future and its determinants. METHODS From 2006 to 2010, 5,410 in-person interview surveys were conducted with childless women as part of the National Survey of Family Growth. Age-specific likelihoods of wanting a baby were compared with likelihoods of having a baby before age 45. Female respondents were 1) born after 1960, 2) age 15 to 44, 3) childless (never given birth to a live infant), and 4) not pregnant at time of interview. FINDINGS Most childless women at any age want a baby sometime in the future. By age 32, fewer than half the childless women who want a baby will have one. At age 39, the majority of childless women (73%) still want a baby someday, but only 7% will have one. By age 45, more than 1 in 10 women will be childless, but still want to have a baby. CONCLUSIONS Although attitudes toward childlessness have become more positive over time, our findings suggest that the United States is experiencing a high prevalence of childless women who want a baby. Clinicians may consider counseling young women about age-related declines in fertility and the costs and success rates of assisted reproductive technologies often required for women with advanced maternal age to better inform their career, family, and lifestyle decisions.