Preference Measurement in Health: Volume 24

The chapter investigates: (1) Do married parents efficiently allocate time to children’s health care? (2) Are parents willing to sacrifice consumption for health improvements at an equal rate for all family members? (3) How does family structure affect health trade-offs parents make? (4) Are parental choices consistent with maximization of a single utility function?

A model is specified focusing on how parents allocate resources between consumption and goods that relieve acute illnesses for family members. Equivalent surplus functions measuring parental willingness to pay to relieve acute illnesses are estimated using data from a stated-preference survey.

Results provide limited support for the prediction that married parents allocate time to child health care according to comparative advantage. Valuations of avoided illness vary between family members and are inconsistent with the hypothesis that fathers’ and mothers’ choices reflect a common utility function.

Prior research on children’s health valuation has relied on a unitary framework that is rejected here. Valuation researchers have focused on allocation of resources between parents and children while ignoring allocation of resources among children, whereas results suggest significant heterogeneity in valuation of health of different types of children and of children in different types of households.

Results may provide a justification on efficiency grounds for policies to provide special protection for children’s health and suggest that benefit–cost analyses of policies affecting health should include separate estimates of the benefits of health improvements for children and adults.

To measure adolescent girls’ preferences over features of human papillomavirus (HPV) vaccines in order to provide quantitative estimates of the perceived benefits of vaccination and potential vaccine uptake.

A discrete choice experiment (DCE) survey was developed to measure adolescent girls’ preferences over features of HPV vaccines. The survey was fielded to a U.S. sample of 307 girls aged 13–17 years who had not yet received an HPV vaccine in June 2008.

In a latent class logit model, two distinct groups were identified – one with strong preferences against vaccination which largely did not differentiate between vaccine features, and another that was receptive to vaccination and had well-defined preferences over vaccine features. Based on the mean estimates over the entire sample, we estimate that girls’ valuation of bivalent and quadrivalent HPV vaccines ranged between $400 and $460 in 2008, measured as willingness-to-pay (WTP). The additional value of genital warts protection was $145, although cervical cancer efficacy was the most preferred feature. We estimate maximum uptake of 54–65%, close to the 53% reported for one dose in 2011 surveillance data, but higher than the 35% for three doses in surveillance data.

We conclude that adolescent girls do form clear opinions and some place significant value on HPV vaccination, making research on their preferences vital to understanding the determinants of HPV vaccine demand.

DCE studies may be used to design more effective vaccine-promotion programs and for reassessing public health recommendations and guidelines as new vaccines are made available.

A rich literature has documented gender-based differences in health care utilization and outcomes. The role of risk attitude in explaining the variations is limited at best. This study examines gender differences in health utilities and risk attitudes.

Data on 13 health states were collected from 629 students via questionnaires at the Ben-Gurion University of the Negev in 2005. From each respondent, we assessed utilities for a subset of health states, using Time Trade-Off and Standard Gamble. A risk attitude coefficient was calculated for each respondent as a function of their utilities for all outcomes assessed. The risk coefficient derived from a closed-form utility model for men was compared to that of women using the t-statistic.

There was a statistically significant difference in the risk attitudes of men and women. Men had a concave utility function, representing risk aversion, while women had a near linear utility function, suggesting that women are risk neutral.

Differences in risk attitude may be an important contributor to gender-based disparities in health services utilization. More research is needed to assess its full impact on decision-making in health care.

Preferences of both Alzheimer patients and their spouse caregivers are related to a willingness-to-pay (WTP) measure which is used to test for the presence of mutual (rather than conventional unilateral) altruism.

Contingent valuation experiments were conducted in 2000–2002, involving 126 Alzheimer patients and their caregiving spouses living in the Zurich metropolitan area (Switzerland). WTP values for three hypothetical treatments of the demented patient were elicited. The treatment Stabilization prevents the worsening of the disease, bringing dementia to a standstill. Cure restores patient health to its original level. In No burden, dementia takes its normal course while caregiver’s burden is reduced to its level before the disease.

The three different types of therapies are reflected in different WTP values of both caregivers and patients, suggesting that moderate levels of Alzheimer’s disease still permit clear expression of preference. According to the WTP values found, patients do not rank Cure higher than No burden, implying that their preferences are entirely altruistic. Caregiving spouses rank Cure before Burden, reflecting less than perfect altruism which accounts for some 40 percent of their total WTP. Still, this constitutes evidence of mutual altruism.

The evidence suggests that WTP values reflect individuals’ preferences even in Alzheimer patients. The estimates suggest that an economically successful treatment should provide relief to caregivers, with its curative benefits being of secondary importance.

This chapter reports estimates of consumers’ preferences for plans to improve food safety.

The plans are distinguished based on whether they address the ex ante risk of food borne illness or the ex post effects of the illness. They are also distinguished based on whether they focus on a public good – reducing risk of illness for all consumers or allowing individual households to reduce their private risks of contracting a food borne pathogen.

Based on a National Survey conducted in 2007 using the Knowledge Network internet panel, our findings indicate consumers favor ex ante risk reductions and are willing to pay approximately $250 annually to reduce the risk of food borne illness. Moreover, they prefer private to public approaches and would not support efforts to reduce the severity of cases of illness over risk reductions.

This study is the first research that allows a comparison of survey respondents’ choices between public and private mechanisms for ex ante risk reductions.

This study contributes to the understanding of the health effects of pesticides exposure and of how pesticides have been and should be regulated.

This study presents literature reviews for the period 2000–2013 on (i) the health effects of pesticides and on (ii) preference valuation of health risks related to pesticides, as well as a discussion of the role of benefit-cost analysis applied to pesticide regulatory measures.

This study indicates that the health literature has focused on individuals with direct exposure to pesticides, i.e. farmers, while the literature on preference valuation has focused on those with indirect exposure, i.e. consumers. The discussion highlights the need to clarify the rationale for regulating pesticides, the role of risk perceptions in benefit-cost analysis, and the importance of inter-disciplinary research in this area.

This study relates findings of different disciplines (health, economics, public policy) regarding pesticides, and identifies gaps for future research.