Theory versus practice: a review of 'willingness-to-pay' in health and health care.
This paper is based upon an extensive review of 71 willingness-to-pay (WTP) surveys of health and health care published in English during the period 1985--1998. The aim of the paper is to outline the arguments advanced for the superiority of WTP over quality-adjusted-life-years (QALYs) as a measure of benefit of health care programmes, and to review how empirical WTP studies adhere to their implications. An important argument is that WTP enables a more comprehensive valuation of benefits than QALYs. Our main focus is therefore to provide a careful review of the scenario descriptions used in the surveys, according to which types of benefits are being valued, and how comprehensively the descriptions are presented. Furthermore, the 'cost-benefit argument', that WTP can assist in improving social efficiency, is discussed before we inquire into the extent to which the studies actually compare WTP with social costs.
Olsen
J A
JA
Institute of Community Medicine, University of Tromsø, Tromsø, Norway. jano@ism.uit.no
Smith
R D
RD
D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D003625:Data Collection / Q000379:methods*; D005382:Financing, Personal; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D019057:Quality-Adjusted Life Years