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Medical Decision Making
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Willingness to Pay for What? A Note on Alternative Definitions of Health Care Program Benefits for Contingent Valuation Studies

Gillian R. Currie, PhD

Department of Economics, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

Cam Donaldson, PhD

Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada, Department of Economics and Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom

Bernie J. O’Brien, PhD

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, Centre for Evaluation of Medicines, St. Joseph’s Hospital, Hamilton, Ontario, Canada

Greg L. Stoddart, PhD

Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada, Canadian Institute for Advanced Research, Toronto, Ontario, Canada

George W. Torrance, PhD

Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada, Centre for Evaluation of Medicines, St. Joseph’s Hospital, Hamilton, Ontario, Canada, Innovus Research Inc., Burlington, Ontario, Canada

Michael F. Drummond, PhD

Centre for Health Economics, University of York, York, United Kingdom

The authors examine a number of ways in which willingness to pay (WTP) can be defined for measurement and use in a cost-benefit analysis (CBA) of a collectively funded health care program. They show how ambiguous specification of the program consequences that respondents should consider in their WTP responses can lead to problems of double counting or zero counting in a subsequent CBA. An example is whether the value of lost time from work because of poor health should be included by a CBA analyst (e.g., valued at the wage rate) as a separate cost item or whether this has already been monetized and included in respondents’ WTP data. The authors highlight how differences in assumed or actual institutional structures are often ignored in measures of WTP and the consequences of this for the interpretation of WTP data.

Key Words: cost-benefit analysis • contingent valuation • willingness to pay

Medical Decision Making, Vol. 22, No. 6, 493-497 (2002)
DOI: 10.1177/0272989X02238301
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