title: Economic valuation of health care services in public health systems: a study about Willingness to Pay (WTP) for nursing consultations.
abstract: BACKGROUND
  Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users.
  
  
  RESULTS
  Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2-15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6-22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4-6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively).
  
  
  CONCLUSIONS
  The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of health services.
authors.affiliation: Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste. Gerencia de Atención Primaria, Madrid, Spain. jmfernandez@salud.madrid.org
authors.forename: Jesús
authors.initials: J
authors.lastname: Martín-Fernández
authors.forename: Ma Isabel
authors.initials: MI
authors.lastname: del Cura-González
authors.forename: Gemma
authors.initials: G
authors.lastname: Rodríguez-Martínez
authors.forename: Gloria
authors.initials: G
authors.lastname: Ariza-Cardiel
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
authors.forename: Tomás
authors.initials: T
authors.lastname: Gómez-Gascón
authors.forename: Elena
authors.initials: E
authors.lastname: Polentinos-Castro
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Pérez-Rivas
authors.forename: Julia
authors.initials: J
authors.lastname: Domínguez-Bidagor
authors.forename: Milagros
authors.initials: M
authors.lastname: Beamud-Lagos
authors.forename: Ma Eugenia
authors.initials: ME
authors.lastname: Tello-Bernabé
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Conde-López
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Aguado-Arroyo
authors.forename: Ma Teresa
authors.initials: MT
authors.lastname: Sanz-Bayona
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Gil-Lacruz
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017060:Patient Satisfaction; D059017:Primary Care Nursing / Q000191:economics; D011320:Primary Health Care / Q000191:economics*; D011634:Public Health / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics; D012959:Socioeconomic Factors