Willingness to pay methods in health care: a sceptical view

A small but growing number of stated pre-ference WTP studies have been conducted in the health field [4,5]. Two main methods have been employed: the'contingent valuation method'(CVM) and'choice experiments'(CE)-the method formerly known as conjoint analysis. These methods have generally been used to set a monetary value on a package of health and/or non-health benefits in the context of a specific intervention. Yet economic evaluation within the health care field remains dominated by cost-e ectiveness and cost-per-QALY analysis. Health care payers have been reluctant to embrace cost-benefit analysis based on WTP methods [6,7]. And most health economists have preferred to refine the cost-e ectiveness approach rather than to develop new WTP methods [8,9]. Why is this? Advocates of WTP methods suggest it may be partly due to a common but erroneous perception that WTP studies are'somehow supportive of policies aimed at remov-ing the provision of state-supplied health services'[1]. It may also be due to the fact that stated preference WTP methods su er from two serious (and possibly related) measurement biases that render them unattractive to health care decision-makers.