Different domains - Different time preferences?

The vast majority of studies examining the relation between time preferences and health behavior have applied a measure of preferences in the financial rather than in the health domain. Most studies find a small but significant correlation. If time preferences for health and money are not the same, this can have substantial consequences for the reliability of these results. In the present paper, we set out to examine potential differences in time preferences between the two domains - money and health. Preferences over time were elicited using a stated preference matching method. Using a split sample design, the health domain was described in the context of back pain. Individuals were to match a certain sooner shorter period of pain relief against a later longer period of pain relief in the health domain, while the match in the financial domain was described as a match between a sooner smaller monetary reward and a larger later monetary reward. Data was collected through an online survey, distributed to a sample of members of fitness dk on the 7th of February 2016 and the 6th of March 2016 yielding a sample of 1687 members. In the analyses we assume quasi-hyperbolic discounting which allows us to estimate both a parameter measuring present bias and a parameter measuring impatience at an individual level. Our results demonstrate remarkably similar time preference estimates for both long term discounting and present biasedness. When analyzing differences between subgroups we observe small but significant differences between time preferences for women, retirees and individuals with a longer education. Our results shows that time preferences measured in the money and health domain in our sample are close to identical but that small differences occur in certain subgroups.

Can present biasedness explain early onset of diabetes and subsequent disease progression? Exploring causal inference by linking survey and register data.

Diabetes is a major cause of morbidity, disability, mortality and health care resource use. The increasing prevalence of diabetes may therefore have dramatic future consequences for western societies. Diabetes entails a significant self-management component and it has previously been estimated that people with diabetes provide about 95% of their own care. Despite increased focus, self-management skills including basic knowledge acquisition, problem solving and setting realistic goals are often not mastered. The main contribution of this paper is to provide evidence that the heterogeneity in self-management and health outcomes amongst diabetes patients is partly attributable to individual differences in time-inconsistent preferences in terms of present biased behaviour. Using a unique data set consisting of survey data from 2014 merged with registry data on a sample of 79 chronically ill patients, we present empirical evidence that present biased individuals are more prone to onset of diabetes at an early age, and have a poorer prognosis after diagnosis. Furthermore, we conclude that present biasedness has a casual effect on the onset and management of diabetes.

Be Careful What You Ask For: Effects of Benefit Descriptions on Diabetes Patients' Benefit-Risk Tradeoff Preferences.

BACKGROUND: As more studies report on patient preferences for diabetes treatment, identifying diabetes outcomes other than glycated hemoglobin (HbA1c) to describe effectiveness is warranted to understand patient-relevant, benefit-risk tradeoffs. OBJECTIVE: The aim of the study was to evaluate how preferences differ when effectiveness (glycemic control) is presented as long-term sequela (LTS) risk mitigation rather than an asymptomatic technical marker (HbA1c). METHODS: People with type 2 diabetes and using insulin (n = 3160) were randomly assigned to four self-administered, discrete-choice experiments that differed by their presentation of effectiveness. Epidemiologic reviews were conducted to ensure a close approximation of LTS risk relative to HbA1c levels. The relative importance of treatment benefit-risk characteristics and maximum acceptable risk tradeoffs was estimated using an error-component logit model. Log-likelihood ratio tests were used to compare parameter vectors. RESULTS: In total, 1031 people responded to the survey. Significantly more severe hypoglycemic events were accepted for a health improvement in terms of LTS mitigation versus HbA1c improvement (0.7 events per year; 95% confidence interval [CI]: 0.4-1.0 vs. 0.2 events per year 95% CI: -0.02 to 0.5) and avoidance of treatment-related heart attack risk (1.4 severe hypoglycemic events per year; 95% CI: 0.8-1.9 vs. 1 event per year; 95% CI: 0.6-1.3). This finding is supported by a log-likelihood test that rejected at the 0.05 level that respondent preference structures are similar across the different experimental arms of the discrete-choice experiment. CONCLUSION: We found evidence that benefit descriptions influence elicited preferences for the benefit-risk characteristics of injectable diabetes treatment. These findings argue for using carefully defined effectiveness measures to accurately take account of the patient perspective in benefit-risk assessments.

Painful dilemmas: A study of the way the public's assessment of animal research balances costs to animals against human benefits.

The conflict between animal costs and human benefits has dominated public as well as academic debates about animal research. However, surveys of public perceptions of animal research rarely focus on this part of attitude formation. This paper traces the prevalence of different attitudes to animal research in the public when people are asked to take benefit and cost considerations into account concurrently. Results from the examination of two representative samples of the Danish public identify three reproducible attitude stances. Approximately 30-35% of people questioned approved of animal research quite strongly, and 15-20% opposed animal research. The remaining 50% were reserved in their views. Further studies will ideally use the measure developed here to make possible relatively fine-grained comparisons and understandings of differences between populations and changes in attitudes over time.

Public preferences for establishing nephrology facilities in Greenland: estimating willingness-to-pay using a discrete choice experiment.

At present there are no nephrology facilities in Greenland. Greenlandic patients with renal failure needing dialysis thus have to travel to Denmark to obtain treatment. For patients in haemodialysis this necessitates a permanent residence in Denmark. Our study was aimed at examining Greenlanders' preferences for establishing nephrology facilities in Greenland at Queen Ingrid's Hospital in Nuuk, and to estimate the associated change in welfare. Preferences were elicited using a discrete choice experiment (DCE). A random sample of 500 individuals of the general population was sent a postal questionnaire in which they were asked to consider the trade-offs of establishing nephrology facilities in Greenland as opposed to the current situation. This involved trading off the benefits of having such facilities in their home country against the costs of the intervention. Besides including a payment attribute described in terms of incremental tax payment, the DCE included two interventions attributes related to (1) the organisation of labour, and (2) the physical settings of the patients. Respondents succeeded in answering the DCE despite cultural and linguistic disparity. We found that all the included attributes had a significant effect on respondents' choices, and that respondents' answers to the DCE were in keeping with their values as stated in the questionnaire. DCE data was analyzed using a random parameter logit model reparametrized in willingness-to-pay space. The results showed that establishing facilities in Greenland were preferred to the current treatment in Denmark. The welfare estimate from the DCE, at DKK 18.74 million, exceeds the estimated annual costs of establishing treatment facilities for patients with chronic renal failure. Given the estimated confidence interval this result seems robust. Establishing facilities in Greenland therefore would appear to be welfare-improving, deriving positive net benefits. Despite the relatively narrow policy focus, we believe that our findings provide some insight into individuals' preferences for decentralization of public services and on citizens' views of 'self-governance' that go beyond the case of Greenland. More generally, this paper illustrates how DCE can be applied successfully to developing countries with culturally, demographically, and geographically distinct features.