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Publicly funded health system reforms increasingly require the evaluation of competing programs. However, programs are made of multidimensional attributes of value (where value refers to latent expectations of health system improvement). This paper identifies the design, implementation and validation of a methodology to elicit health system values to guide health care priority setting. The exercise suggests that the proposed mixed methods methodology is suitable for eliciting and validating health system values, and its findings show that pursuing health gain alone does not fully capture the dimensions of health system value. More specifically, we identify a list of health system values (elicited by both potential and actual users) and classify them in terms of process related values (e.g., shorter waiting lists, greater choice etc) and improvements in health system equity in addition to value derived from health gain.

The distribution of income related health inequalities appears to exhibit changing patterns when both developing countries and developed countries are examined. This paper tests for the existence of a health Kuznets' curve, that is an inverse U-shape pattern between economic developments measured by GDP per capita) and income-related health inequalities (as measured by concentration indices). We draw upon both cross section (the World Health Survey) and a long longitudinal (the European Community Household Panel survey) dataset. Our results suggest evidence of a health Kuznets' curve on per capita income. Our findings point towards the existence of a polynomial association where inequalities decline when GDP per capita reaches a magnitude ranging between $26,000 and $38,700.That is, income-related health inequalities rise with GDP per capita, but tail off once a threshold level of economic development has been attained.

Budget experiments can provide additional guidance to heath system reform requiring the identification of a subset of programs and services that accrue the highest social value to ‘communities’. Such experiments simulate a realistic budget resource allocation assessment among competitive programs, and position citizens as decision makers responsible for making ‘collective sacrifices’. This paper explores the use of a participatory budget experiment (with 88 participants clustered in social groups) to model public health care reform, drawing from a set of realistic scenarios for potential health care users. We measure preferences by employing a contingent ranking alongside a budget allocation exercise (termed ‘willingness to assign’) before and after program cost information is revealed. Evidence suggests that the budget experiment method tested is cognitively feasible and incentive compatible. The main downside is the existence of ex-ante “cost estimation” bias. Additionally, we find that participants appeared to underestimate the net social gain of redistributive programs. Relative social value estimates can serve as a guide to aid priority setting at a health system level.

Culture is an under-studied determinant of health production and seldom measured. This paper empirically examines the persistence in the association between the health capital assessments of first and second-generation migrants with that of their ancestral countries. We draw on European data from 30 countries, including over 90 countries of birth and control for timing of migration, selective migration and other controls including citizenship and cultural proxies. Our results show robust evidence of cultural persistence of health assessments. Culture persists, rather than fades, and further, appears to strengthen over generations. We estimate a one standard deviation increase in ancestral health assessment increases first generation migrant’s health assessments by an average of 16%, and that of second generation migrants between 11% and 25%. Estimates are heterogeneous by gender (larger for males) and lineage (larger for paternal lineage).

While some methods for eliciting preferences to assist participatory priority setting in health care in developed countries are available, the same is not true for poor communities in developing countries whose preferences are neglected in health policy making. Existing methods grounded on self-interested monetary valuations may be inappropriate for developing country settings where community care is provided through ‘social allocation’ mechanisms. This paper proposes and examines an alternative methodology for eliciting preferences for health care programs specifically catered for rural and less literate populations but which is still applicable in urban communities. Specifically, the method simulates a realistic collective budget allocation experiment, to be implemented in both rural and urban communities in Guatemala. We report evidence revealing that participatory budget-like experiments are incentive compatible mechanisms suitable for revealing collective preferences, while simultaneously having the advantage of involving communities in health care reform processes.

Why do individuals still use traditional medicines when modern treatments are available? Economic explanations for an individual’s use of traditional instead of modern medicines are scarce and often fail to consider explanations beyond the conventional. This paper puts forward an economic explanation for the use of traditional medicine. First, traditional medicines were the default form of health care available in pre-colonial times where industry influence was yet to develop. Hence, both those individuals who exhibit lower incomes and are left out of health insurance coverage are more likely to use traditional medicines. Second, cultural attitudes and ethnic group controls explain variation in utilisation, even among those who have health insurance. Results are suggestive of the validity of cultural interpretations.

To date, the scientific evidence on traditional medicines is scant and under-developed, yet, paradoxically individuals continue to use it and claim high satisfaction levels. What can explain this effect? Using self-collected data from Ghana we argue that variations in satisfaction across individuals can be attributed to the hedonic placebo effect gained from using traditional medicines, in which processes involved with its consumption are as important, if not more important, than measures of self-reported health outcome. Findings suggest that individuals’ health seeking behaviour should be evaluated using procedural, as well as outcome, utility.

Traditional medicines (TM) are known to be popular in sub-Saharan Africa, where over 80% have reported its utilisation. It is claimed to be easily accessible, affordable, available and acceptable, but little is known about at which stage of treatment seeking individuals turn to traditional medicines. This is owing to a paucity in quantitative demand data on how many recourses of care people take for one episode of illness, whether individuals use traditional medicines as a secondary option to orthodox medicines, and if used, how satisfied they are with results. This study presents descriptive data from fieldwork carried out on 772 households in two regions of Ghana to ascertain actions taken for self reported episodes of acute and previously diagnosed chronic diseases. Quantitative results show by looking merely at first recourse, use of traditional medicines is fairly low, but once second recourses are accounted for there is a doubling and tripling of incidence of TM use for acute and chronic diseases respectively. A commonly used patient reported outcome measurement, the EQ5D, is adopted to measure satisfaction before and after traditional medicine use, to reveal significantly positive changes. The study suggests that whilst these results show individuals to be highly satisfied with TM, it is more often the second recourse of treatment with a revealed preference for orthodox medicines as a first recourse. This suggests that policy must investigate why individuals turn to TM only as a second recourse and clarify the insufficiencies of orthodox treatment. Policies which guide individuals to taking the most efficient recourses for given symptoms and further exploration of key reasons behind high levels of satisfaction following utilization are encouraged.