Willingness to Pay in Caregivers of Patients Affected by Schizophrenia.

BACKGROUND: Schizophrenia is a debilitating disorder that often requires the affected individual to receive care from a caregiver. Willingness to Pay (WTP) technique allows a valuation of the health state preferences by assessing the impact of the disease and translating it into monetary terms. AIMS OF THE STUDY: The objective was to determine the WTP of schizophrenic patients' caregivers on a hypothetical recovery scenario and correlate it to socio-demographic and clinical characteristics, Knowledge of Disease, Quality of life and Burden of Disease. METHODS: A convenience sample consecutively assessed 189 outpatients' caregivers from Schizophrenia Program of Federal University of Sao Paulo. A single caregiver was considered for each patient, taking into consideration their close relationship and their direct involvement in the treatment. Open WTP questionnaire for a hypothetical schizophrenia recovery scenario, KAST (Knowledge of Disease), SF-6D (Quality of life) and ZBI-22 (Burden of Disease) scales were applied. RESULTS: A monthly WTP mean value (SD) of US\USD 63.63 (111.88) was found. The average value (SD) found was 12.96 (2.45) on KAST, 0.78 (0.08) on SF6D and 29.91 (16.10) on ZARIT. Income, education, social class, knowledge of disease and burden of caregiver were positively correlated to the WTP value. By linear regression model, income and education remained significant. CONCLUSION: Willingness to Pay (WTP) is a method that can be used to determine the strength of preference of patients and caregivers for a recovery in schizophrenia. The higher the income and education, the higher the willingness to pay. No clinical characteristics of patients had a statistically significant relation to the value the caregiver would pay. IMPLICATIONS FOR HEALTH POLICIES: WTP is a potentially useful tool to determine values and health care preferences, and can be used for the development of mental health policies. IMPLICATIONS FOR FURTHER RESEARCH: Future research should be used to enhance WTP tool in mental health studies on the impact of diseases, including schizophrenia.

Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service.

Choice in public services is controversial. We exploit a reform in the English National Health Service to assess the effect of removing constraints on patient choice. We estimate a demand model that explicitly captures the removal of the choice constraints imposed on patients. We find that, post-removal, patients became more responsive to clinical quality. This led to a modest reduction in mortality and a substantial increase in patient welfare. The elasticity of demand faced by hospitals increased substantially post- reform and we find evidence that hospitals responded to the enhanced incentives by improving quality. This suggests greater choice can raise quality.

Learning effect of a conditional cash transfer programme on poor rural women's selection of delivery care in Mexico.

BACKGROUND The Mexican programme Oportunidades/Progresa conditionally transfers money to beneficiary families. Over the past 10 years, poor rural women have been obliged to attend antenatal care (ANC) visits and reproductive health talks. We propose that the length of time in the programme influences women's preferences, thus increasing their use not only of services directly linked to the cash transfers, but also of other services, such as clinic-based delivery, whose utilization is not obligatory. OBJECTIVE To analyse the long-term effect of Oportunidades on women's use of antenatal and delivery care. METHODOLOGY 5051 women aged between 15 and 49 years old with at least one child aged less than 24 months living in rural localities were analysed. Multilevel probit and logit models were used to analyse ANC visits and physician/nurse attended delivery, respectively. Models were adjusted with individual and socio-economic variables and the locality's exposure time to Oportunidades. Findings On average women living in localities with longer exposure to Oportunidades report 2.1% more ANC visits than women living in localities with less exposure. Young women aged 15-19 and 20-24 years and living in localities with longer exposure to Oportunidades (since 1998) have 88% and 41% greater likelihood of choosing a physician/nurse vs. traditional midwife for childbirth, respectively. Women of indigenous origin are 68.9% less likely to choose a physician/nurse for delivery care than non-indigenous women. CONCLUSIONS An increase in the average number of ANC visits has been achieved among Oportunidades beneficiaries. An indirect effect is the increased selection of a physician/nurse for delivery care among young women living in localities with greater exposure time to Oportunidades. Disadvantaged women in Mexico (indigenous women) continue to have less access to skilled delivery care. Developing countries must develop strategies to increase access and use of skilled obstetric care for marginalized women.

Socioeconomic differences in preferences and willingness-to-pay for insulin delivery systems in type 1 and type 2 diabetes.

BACKGROUND: An evaluation of patients' preferences is necessary to understand the demand for different insulin delivery systems. The aim of this study was to investigate the association between socioeconomic status (SES) and patients' preferences and willingness to pay (WTP) for various attributes of insulin administration for diabetes management. METHODS: We conducted a discrete choice experiment (DCE) to determine patients; preferences and their WTP for hypothetical insulin treatments. Both self-reported annual household income and education completed were used to explore differences in treatment preferences and WTP for different attributes of treatment across different levels of SES. RESULTS: The DCE questionnaire was successfully completed by 274 patients. Overall, glucose control was the most valued attribute by all socioeconomic groups, while route of insulin delivery was not as important. Patients with higher incomes were willing to pay significantly more for better glucose control and to avoid adverse events compared to lower income groups. In addition, they were willing to pay more for an oral short-acting insulin ($Can 71.65 [95% confidence interval, $40.68, $102.62]) compared to the low income group ($Can 9.85 [95% confidence interval, 14.86, 34.56; P < 0.01]). Conversely, there were no differences in preferences when the sample was stratified by level of education. CONCLUSIONS: This study revealed that preferences and WTP for insulin therapy are influenced by income but not by level of education. Specifically, the higher the income, the greater desire for an oral insulin delivery system, whereas an inhaled route becomes less important for patients.