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This paper analyses how French general practitioners? (GPs) labour supply would respond to changes in their fee per consultation, seeking to determine whether there is a backward-bending curve.?Because French GPs? fees only evolve very slowly and are generally fixed by the National Health Insurance Fund, fee variability is not sufficient to observe changes in labour supply.?Therefore, we designed a contingent valuation survey randomly presenting GPs with three hypothetical fee increases.?Empirical evidence from 1,400 GPs supports the hypothesis of a negative slope in their labour supply curve.?This suggests that increasing fees is not an effective policy to increase the supply of medical services. JEL Codes: C21, I12, J22, J4.
BRCA1/2 carriers have a higher risk of developing breast and ovarian cancer at a younger age. Preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND) are two of the few options available to avoid transmitting the mutation. To inform the bioethics debate about authorization, a contingent valuation survey elicited preferences regarding access to PGD and PND from a sample of 460 unaffected by cancer BRCA1/2 carriers (GENEPSO cohort). We find that the respondents can be classified into three groups: one opposed to PGD/PND (28.3%), one strongly in favour of PGD/PND (45.8%), and one in an intermediate position (25.9%). We look for the determinants of these preferences, especially of the willingness to pay for PGD/PND. Overall, we find that BRCA1/2 carriers support access to PGD/PND, which has implications for recommendations to decision-makers.
The choice of elicitation format is a crucial but tricky aspect of stated preferences surveys. It affects not only the quantity and quality of the information collected on respondents’ willingness to pay (WTP) but also the potential errors/biases that prevent their true WTP from being observed.
We propose a new elicitation mechanism, the circular payment card (CPC), and show that it helps overcome the drawbacks of the standard payment card (PC) format. It uses a visual pie chart representation without start or end points: respondents spin the circular card in any direction until they find the section that best matches their true WTP.
We performed a contingent valuation survey regarding a mandatory health insurance scheme in Tunisia, a middle-income country. Respondents were randomly allocated into one of three subgroups and their WTP was elicited using one of three formats: open-ended (OE), standard PC and the new CPC. We compared the elicited WTP.
We found significant differences in unconditional and conditional analyses. Our empirical results consistently indicated that the OE and standard PC formats led to significantly lower WTP than the CPC format.
Overall, our results are encouraging and suggest CPC could be an effective alternative format to elicit ‘true’ WTP.
Dans le secteur des transports, les émissions de gaz à effet de serre (GES) et de polluants atmosphériques locaux (PAL) sont analysées de manière indépendante non seulement lors de la fixation des normes d’émissions, mais également dans l’analyse économique. Puisqu’elles ont la même origine (le pétrole), nous proposons d’étudier les conséquences de leur traitement joint sur le choix d’une politique de transport. Dans un premier temps, nous mettons en évidence les relations existant entre les impacts sanitaires et socio-économiques associés à ces deux sources de pollution, et rappelons les modalités de leur évaluation monétaire. Nous établissons ensuite que la politique de transport à privilégier, lorsque les GES et les PAL sont pris en compte conjointement avec leurs incertitudes et irréversibilités respectives, favorise la diminution du transport privé motorisé. Nous discutons enfin les implications pratiques de ce résultat en matière de choix sociétaux.
Natural disasters due to climate change (like floods, hurricanes, heat waves or droughts) combine a risk of large losses and a low probability of occurrence, requiring decisions to be made in uncertain universes. However, the inability of standard decision under uncertainty models to provide rankings when some outcomes are catastrophic impedes rational (public) decision-making. This paper examines the role of emotions in individuals’ choices among alternatives involving catastrophic events, either in real life (flooding) or artificial (laboratory experiment) situations. We report a survey on 599 respondents aimed at determining how people exposed to different levels of flood risk form beliefs and make decisions under uncertainty before and after emotion-generating events. Data on their emotions, the emotions they expect to experience, their personality and psychological determinants, their symptoms before and after emotion-generating events are collected and analyzed. In parallel with this survey, experimental protocols replicate the emotional experience of a catastrophe and measure its impact on behavior and formation of beliefs. Emotions are induced by framing effects and measured through a self-declared worry scale. We collect behavioral data (insurance choice, subjective beliefs, performance) and measure how they are affected by the emotions felt during the decision-making. These protocols test some assumptions in the survey using experimental paradigms from psychophysics that allow us to control the sources of uncertainty experienced by the subjects. Results confirm that emotions connected with the nature of the risk can significantly affect desire to reduce it. The survey provides valuable material for comparative analysis, revealing how actual experience of an anticipated event affects decisions. The experiments show that emotions affect the decision-making process and the forming of probabilistic beliefs.
Public decision-makers commonly use health impact assessments (HIA) to quantify the impacts of various regulation policies. However, standard HIAs do not consider that chronic diseases (CDs) can be both caused and exacerbated by a common factor, and generally focus on exacerbations. As an illustration, exposure to near road traffic-related pollution (NRTP) may affect the onset of CDs, and general ambient or urban background air pollution (BP) may exacerbate these CDs. We propose a comprehensive HIA that explicitly accounts for both the acute effects and the long-term effects, making it possible to compute the overall burden of disease attributable to air pollution. A case study applies the two HIA methods to two CDs—asthma in children and coronary heart disease (CHD) in adults over 65—for ten European cities, totaling 1.89 million 0–17-year-old children and 1.85 million adults aged 65 and over. We compare the current health effects with those that might, hypothetically, be obtained if exposure to NRTP was equally low for those living close to busy roads as it is for those living farther away, and if annual mean concentrations of both PM10 and NO2—taken as markers of general urban air pollution—were no higher than 20 μg/m3. Returning an assessment of € 0.55 million (95 % CI 0–0.95), the HIA based on acute effects alone accounts for only about 6.2 % of the annual hospitalization burden computed with the comprehensive method [€ 8.81 million (95 % CI 3–14.4)], and for about 0.15 % of the overall economic burden of air pollution-related CDs [€ 370 million (95 % CI 106–592)]. Morbidity effects thus impact the health system more directly and strongly than previously believed. These findings may clarify the full extent of benefits from any public health or environmental policy involving CDs due to and exacerbated by a common factor.
Local land-use policies are determined by a wide range of considerations that do not always favor open-space preservation. To identify them, a field study was undertaken in South Eastern France via semi-directive interviews with people responsible for municipal land-use policies. We use it to compare a qualitative (i.e. manual) discourse analysis with two quantitative (i.e. computer-assisted) analyses and combine them to identify the drivers of land-use policies, especially with regard to urban sprawl. Performing all three analyses allows us to switch back and forth between a local empirical approach and large-scale modeling and methods. This should enrich micro-economic models by clarifying more complex local features, like unbalanced relationships with neighboring municipalities or why “agriculture” should be considered as an independent interest group.
L'évaluation des impacts sanitaires et économiques de la pollution atmosphérique constitue un enjeu majeur pour la population et pour les décideurs. Impliqués de longue date dans ce domaine, nous ne pouvons que nous féliciter de la parution de l'article de Rafenberg et al. (2015). II contribue en effet à la prise en compte de la morbidité chronique dans l'évaluation économique des effets de la pollution atmosphérique, une voie que le projet Aphekom avait également exploré par d'autres approches. Il nous a pourtant semblé nécessaire de clarifier un certain nombre de points relatifs à cette publication. Nous commencerons par évoquer les questions de méthodes. Nous aborderons ensuite la présentation et l'interprétation de certaines études discutées dans Rafenberg et al. (2015), car la présence d'erreurs relativise la portée de certains points de la discussion de cet article.
We extend the individual dynamic model of lifetime resource allocation to assess the monetary value given to the increase in survival probabilities for every member of a household induced by improved air quality. We interpret this monetary value as VPF (value of a prevented fatality), which can also be expressed as a flow of discounted VOLY (value of life years) lost, and account for potential altruism towards other household members. We use a French air pollution contingent valuation survey that provides a description of the life-length reduction implied by a change in air pollution exposure. By privatising the public commodity air pollution, we succeed in ruling out any form of altruism (towards others living today and towards future generations) except altruism towards one's family. We estimate a mean VOLY of € 2001 140,000, a 30% premium for VOLY in perfect health w.r.t. average expected health status, and a mean VPF of € 2001 1.45 million for the respondent, all context-specific. In addition, we find an inverted U-shaped relationship between his/her age and VOLY/VPF, and significant benevolence only towards children under 18.
In this paper, we propose a behavioral approach to determine the extent to which the consumer/citizen distinction affects interpretations of monetary values in stated preferences methods. We perform a field experiment dealing with air pollution, where some (randomly selected) subjects are given the opportunity to behave politically by signing a petition for environmental protection prior to stating their private preferences in a standard contingent valuation exercise. We show that signing has the potential to influence respondents' willingness to pay values. Results indicate that even market-like situations are not immune to citizen behavior.