Academic journal article Applied Health Economics and Health Policy

Willingness to Pay for Maternal Health Outcomes: Are Women Willing to Pay More Than Men?

Academic journal article Applied Health Economics and Health Policy

Willingness to Pay for Maternal Health Outcomes: Are Women Willing to Pay More Than Men?

Article excerpt

Background

In recent years, a substantial number of health and health-related contingent valuation (CV) studies have been conducted in low- and middle-income countries. The vast majority of these studies have included the sex of the respondent as an explanatory variable in their analysis. However, only a limited number of studies have specifically sought to analyse and try to understand sex differences in willingness to pay (WTP).[1,2] This article seeks to add to our understanding of the role of sex in determining WTP values.

The article builds on a small existing literature of health and health-related studies in developing countries specifically focused on sex differences in WTP. Dong et al.[1] analysed differences between male and female WTP for community-based health insurance in Burkina Faso. The authors found that differences in socioeconomic status, such as education and income, influenced differences in WTP values. Perhaps not unexpectedly because of their disadvantage in terms of socioeconomic status, women were found to have a significantly lower WTP than men. Mujinja et al.[2] conducted a CV survey in Tanzania for insecticide-treated bed nets and analysed the socioeconomic and malaria-related differences between male and female values that may give rise to sex differences in WTP. The authors found that, although the average income of men in the survey was twice that of women, there were no significant differences in WTP between the sexes. Consequently, this implied that, as a percentage of income, women were willing to pay twice as much as men. The authors suggested that differences in WTP may arise from differences in preferences for the goods in question, systematic differences in the way that men and women answer WTP questions, and the degree of poverty in the study population.

Although these studies quantify differences in values between men and women, there has been little attempt to gain further insight into why such differences remain after controlling for socioeconomic status. There is widespread recognition that responses among men and women are likely to be affected by observable individual characteristics. For example, individuals with higher income may be expected to be willing to pay more, on the basis of their greater ability to pay. In addition, individuals with higher educational status may be more likely to be willing to pay more, as they may be more aware of the adverse consequences of ill health or death. An alternative explanation, arising from the Grossman model,[3] is that individuals with a higher level of education are more efficient at producing health and are therefore willing to place more resources into health production. Age could also influence WTP; however, the direction of the effect is uncertain, and partly determined by the nature of the good being valued. For example, in the context of valuation of reproductive or maternal health, individuals of reproductive age may state a higher WTP than those of post-reproductive age. Experience of ill health or death may also affect responses. Through greater knowledge of the consequences, individuals with previous experience of health complications or sudden deaths in their household may pay more to avoid such events in the future. On the other hand, through adjustment and coping, responses may not be affected among some respondents. Responses may also be determined by unobservable characteristics. One unobservable characteristic is an individual's control over household resources, which is a determinant of an individual's ability to pay. Reported income may be a weak proxy for ability to pay, as it may not accurately reflect an individual's control over household resources.

The association between WTP and ability to pay is well documented.[4,5] Some studies that have conducted WTP surveys in developing-country contexts have found little association between WTP and ability to pay. For example, Walraven[6] conducted a WTP survey in Tanzania to investigate inpatients', outpatients' and households' WTP for hospital services and WTP for an insurance scheme. …

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