Disposição para pagar uma intervenção para melhorar o controlo da hipertensão em hipertensos não controlados : um estudo-piloto

RESUMO - A valorização económica de intervenções preventivas pode contribuir para melhorar a afetação de recursos em saúde. A hipertensão, primeira causa de morte em Portugal, é um grave problema de saúde Pública e o principal fator de risco para a ocorrência de Acidente Vascular Cerebral (AVC). O presente estudo é um primeiro ensaio para quantificar a disposição para pagar (DPP) da sociedade por uma intervenção de promoção da adesão à terapêutica em hipertensos não controlados. Foi aplicado um questionário presencial a uma amostra de conveniência (n=93), numa perspetiva ex post, sendo o questionário constituído por dois formatos de questões e dois cenários de diferentes reduções de pressão arterial sistólica (cenário 1 corresponde à redução de 10 mmHg e cenário 2 à redução de 20 mmHg). O risco de AVC a 10 anos foi adaptado à idade e ao sexo de cada participante. Relativamente ao cenário 1, a DPP média foi de €25,87 e €33,93, dependendo do formato da questão (resposta aberta ou bidding game, respetivamente). Na questão de resposta aberta, 78,3% dos participantes estavam dispostos para pagar pela intervenção, no bidding game 75,6% dos participantes referiram estar dispostos para pagar pelo menos €10. No cenário 2, a DPP média foi de €26,81 e €34,79, dependendo se o formato da questão era do tipo resposta aberta ou bidding game, respetivamente. Na questão de resposta aberta, 84,3% dos participantes estavam dispostos para pagar pela intervenção, no bidding game 76,1% dos participantes referiram estar dispostos para pagar pelo menos €10. Ao contrário do bidding game, nas questões de resposta aberta verificou-se 25,8% e 24,7% de respostas “não sei”, para o cenário 1 e cenário 2 respetivamente, diretamente relacionada com a baixa escolaridade dos participantes (p=0,004). Também se verificou uma maior tendência para respostas às questões de bidding game com valores mais elevados, comparativamente às questões de resposta aberta. Identificaram-se duas variáveis explicativas para os valores DPP: o rendimento e a ocupação principal. A sensibilidade dos respondentes à magnitude dos ganhos em saúde foi verificada internamente em cada questionário (os participantes referiram DPP mais elevadas no cenário 2 relativamente ao cenário 1), no entanto, os participantes que beneficiariam mais da intervenção não demonstraram DPP superiores aos restantes. Para confirmar os efeitos identificados neste estudo e extrapolá-los para a população portuguesa é necessário realizar um estudo representativo de população portuguesa.

Recherche économique en santé cardiovasculaire

Les nouvelles technologies médicales contribuent aux dépenses en santé qui ne cessent de croître, alors que les budgets se trouvent limités. L’évaluation économique des technologies devraient permettre d’identifier quelles sont celles qui sont les plus rentables. Malgré cela, plusieurs technologies dont le rapport coût-efficacité reste plutôt limite ou défavorable sont utilisées en médecine moderne et remboursées par notre système public de santé. Ce mémoire se concentre sur deux technologies en santé cardiovasculaire dont le rapport coût-efficacité est plutôt limite mais qui sont fréquemment utilisées au Canada; les tuteurs médicamentés ou pharmaco-actifs et les défibrillateurs cardiaques implantables (DCI). Nous avons fait une évaluation contingente de ces technologies dans le but d’examiner si ce type d’évaluation économique complémentaire pouvait procurer un point de vue nouveau sur la valeur économique et sociétaire des ces technologies. Les résultats de ces deux évaluations indiquent que les patients accordent une grande importance aux bénéfices que procurent ces deux technologies. Nos résultats soutiennent les politiques de santé actuelles de rembourser de façon libérale ces deux technologies.

Salud y crecimiento económico: un modelo de generaciones traslapadas, expectativa de vida endógena y capital humano

Este trabajo desarrolla un modelo de generaciones traslapadas con expectativa de vida endógena y capital humano. Recoge parte de la evidencia empírica acerca de la transición demográfica explicada por Notestein en 1945, donde variaciones en la longevidad de los individuos afectan positivamente el crecimiento económico de un país. El modelo establece que la falta de incentivos para invertir en salud estanca a una economía en una trampa de pobreza y muestra que incrementos en la productividad en el sector de producción de capital humano, al igual que cambios tecnológicos sesgados al uso intensivo del mismo, incrementan el producto de estado estacionario y pueden sacar a una economía de una trampa de pobreza.

Consumer attitudes towards and willingness to pay for pesticide residue limit compliant 'safe' vegetables in Northeast Thailand

Pesticide residue in vegetables is a major food safety issue in Thailand. A range of vegetable products (organic/pesticide-free/ hydroponic) has emerged in Thai markets that guarantee compliance with maximum residue limits. The Government of Thailand is eager to extend the benefits of this suite of alternative vegetables to the entire population, particularly the semi-urban/rural segments that are often bypassed by such speciality products. However, little information is available to guide such an effort, particularly with regard to up-country consumer attitudes, shopping and consumption habits and willingness to pay premiums for such produce. This research aims to fill this gap in knowledge. It reports the results of a survey of vegetable consumption and shopping habits and attitudes of 608 consumers in northeast Thailand. Willingness to pay premiums for pesticide residue limit compliant vegetables is also assessed by using a contingent valuation method, and determinants of willingness to pay are examined using an ordered probit empirical model. Results indicate that, given adequate awareness of relative risks, even up-country consumers are willing to pay market premium levels for these products, and that inadequate availability, rather than lack of demand is the constraining factor. Willingness to pay is found to increase with income, age and supermarket sourcing of vegetables. We also discuss the challenge of improving availability at mainstream outlets.

Farm animal welfare, consumer willingness to pay, and trust: results of a cross-national survey

Higher animal welfare standards increase costs along the supply chain of certified animal-friendly products (AFP). Since the market outcome of certified AFP depends on consumer confidence toward supply chain operators complying with these standards, the role of trust in consumer willingness-to-pay (WTP) for AFP is paramount. Results from a contingent valuation survey administered in five European Union countries show that WTP estimates were sensitive to robust measures of consumer trust for certified AFP. Deriving the WTP effect of a single food category on total food expenditure is difficult for survey respondents; hence, a budget approach was employed to facilitate this process.

Quantifying the value of ecosystem services: a case study of honeybee pollination in the UK

There is concern that insect pollinators, such as honey bees, are currently declining in abundance, and are under serious threat from environmental changes such as habitat loss and climate change; the use of pesticides in intensive agriculture, and emerging diseases. This paper aims to evaluate how much public support there would be in preventing further decline to maintain the current number of bee colonies in the UK. The contingent valuation method (CVM) was used to obtain the willingness to pay (WTP) for a theoretical pollinator protection policy. Respondents were asked whether they would be WTP to support such a policy and how much would they pay? Results show that the mean WTP to support the bee protection policy was £1.37/week/household. Based on there being 24.9 million households in the UK, this is equivalent to £1.77 billion per year. This total value can show the importance of maintaining the overall pollination service to policy makers. We compare this total with estimates obtained using a simple market valuation of pollination for the UK.

Farmers’ willingness to pay for a tuberculosis cattle vaccine

We use contingent valuation (CV) and choice experiment (CE) methods to assess cattle farmers’ attitudes to and willingness to pay (WTP) for a bovine tuberculosis (bTB) cattle vaccine, to help inform vaccine development and policy. A survey questionnaire was administered by means of telephone interviews to a stratified sample of 300 cattle farmers in annually bTB-tested areas in England and Wales. Farmers felt that bTB was a major risk for the cattle industry and that there was a high risk of their cattle getting the disease. The CE estimate produced a mean WTP of £35 per animal per single dose for a vaccine that is 90% effective at reducing the risk of a bTB breakdown and an estimated £55 for such a vaccine backed by 100% insurance of loss if a breakdown should occur. The CV estimate produced a mean WTP of nearly £17 per dose/per animal/per year for a vaccine (including 100% insurance) which, given the average lifespan of cattle, is comparable to the CE estimate. These WTP estimates are substantially higher than the expected cost of a vaccine which suggests that farmers in high risk bTB ‘hotspot’ areas perceive a substantial net benefit from buying the vaccine.

Social consensus, moral intensity and willingness to pay to address a farm animal welfare issue

An experimental contingent valuation (CV) survey of university students was undertaken to explore the impact of social consensus information on people's stated willingness to pay (wtp) to address a farm animal welfare issue. The survey found that additional information presented to respondents on social consensus concerning the moral dimensions of the issue led to a greater perception of social consensus by respondents. This greater perception of social consensus appeared to result in a higher level of moral intensity associated with the issue and a higher stated wtp by respondents for policy to address the issue. However, as for many CV studies of public goods, a question remains as to whether the estimated wtp is a true measure of people's preferences and relative values or merely a measure of attitudes on an arbitrary monetary scale.

Moral intensity and willingness to pay concerning farm animal welfare issues and the implications for agricultural policy

An experimental survey was undertaken to explore the links between the characteristics of a moral issue, the degree of moral intensity/moral imperative associated with the issue (Jones, 1991), and people's stated willingness to pay (wtp) for policy to address the issue. Two farm animal welfare issues were chosen for comparison and the contingent valuation method was used to elicit people's wtp. The findings of the survey suggest that increases in moral characteristics do appear to result in an increase in moral intensity and the degree of moral imperative associated with an issue. Moreover, there was a positive link between moral intensity/moral imperative associated with an issue and people's stated wtp for policy to address the issue. The paper discusses the relevance of the findings of the survey in the context of the debate concerning the relationship between moral and economic values and the use of the contingent valuation method to estimate people's wtp of policy options with moral dimensions.

Measuring the consumer benefits of improving farm animal welfare to inform welfare labelling

Policy makers in the European Union are envisioning the introduction of a community farm animal welfare label which would allow consumers to align their consumption habits with their farm animal welfare preferences. For welfare labelling to be viable the market for livestock products produced to higher welfare standards has to be sufficiently segmented with consumers having sufficiently distinct and behaviourally consistent preferences. The present study investigates consumers’ preferences for meat produced to different welfare standards using a hypothetical welfare score. Data is obtained from a contingent valuation study carried out in Britain. The ordered probit model was estimated using Bayesian inference to obtain mean willingness to pay. We find decreasing marginal WTP as animal welfare levels increase and that people’s preferences for different levels of farm animal welfare are sufficiently differentiated making the introduction of a labelling scheme in the form of a certified rating system appear feasible.

Consumer attitudes to injurious pecking in free range egg production

Free range egg producers face continuing problems from injurious pecking (IP) which has financial consequences for farmers and poor welfare implications for birds. Beak trimming has been practised for many years to limit the damage caused by IP, but with the UK Government giving notification that they intend to ban beak trimming in 2016, considerable efforts have been made to devise feasible housing, range and management strategies to reduce IP. A recent research project investigated the efficacy of a range of IP reducing management strategies, the mean costs of which came to around 5 pence per bird. Here, the results of the above project’s consumer survey are presented: consumers’ attitudes to free range egg production are detailed showing that, whilst consumers had a very positive attitude towards free range eggs, they were especially uninformed about some aspects of free range egg production. The contingent valuation technique was used to estimate the price premium consumers would be prepared to pay to ensure that hens do not suffer from IP: this was calculated as just over 3% on top of the prevailing retail price of free range eggs. These findings reinforce other studies that have found that whilst consumers are not generally well-informed about certain specific welfare problems faced by animals under free range conditions, they are prepared to pay to improve animal welfare. Indeed, the study findings suggest that producers could obtain an additional price premium if they demonstrate the welfare provenance of their eggs, perhaps through marketing the eggs as coming from birds with intact beaks. This welfare provenance issue could usefully be assured to consumers by the introduction of a mandatory, single, accredited EU-wide welfare-standards labelling scheme.

Características econômicas do valor de uso e de não uso de parques sobre dunas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Valuing damage and losses in cultural assets after a disaster: concept paper and research options

Includes bibliography

Atropelamento de vertebrados nas rodovias MG-428 e SP-334 com análise dos fatores condicionantes e valoração econômica da fauna

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The Economics of Threatened Species Conservation: A Review and Analysis

Stabilizing human population size and reducing human-caused impacts on the environment are keys to conserving threatened species (TS). Earth's human population is ~ 7 billion and increasing by ~ 76 million per year. This equates to a human birth-death ratio of 2.35 annually. The 2007 Red List prepared by the International Union for Conservation of Nature and Natural Resources (IUCN) categorized 16,306 species of vertebrates, invertebrates, plants, and other organisms (e.g., lichens, algae) as TS. This is ~ 1 percent of the 1,589,161 species described by IUCN or ~ 0.0033 percent of the believed 5,000,000 total species. Of the IUCN’s described species, vertebrates comprised relatively the most TS listings within respective taxonomic categories (5,742 of 59,811), while invertebrates (2,108 of 1,203,175), plants (8,447 of 297,326), and other species (9 of 28,849) accounted for minor class percentages. Conservation economics comprises microeconomic and macroeconomic principles involving interactions among ecological, environmental, and natural resource economics. A sustainable-growth (steady-state) economy has been posited as instrumental to preserving biological diversity and slowing extinctions in the wild, but few nations endorse this approach. Expanding growth principles characterize most nations' economic policies. To date, statutory fine, captive breeding cost, contingent valuation analysis, hedonic pricing, and travel cost methods are used to value TS in economic research and models. Improved valuation methods of TS are needed for benefit-cost analysis (BCA) of conservation plans. This Chapter provides a review and analysis of: (1) the IUCN status of species, (2) economic principles inherent to sustainable versus growth economies, and (3) methodological issues which hinder effective BCAs of TS conservation.