Chanel

Publications

Estimating willingness to pay for public health insurance while accounting for protest responses: A further step towards universal health coverage in Tunisia?Journal articleMohammad Abu-Zaineh, Olivier Chanel et Khaled Makhloufi, The International Journal of Health Planning and Management, Volume 37, Issue 5, pp. 2809-2821, 2022

Introduction:
Developing countries face major challenges in implementing universal health coverage (UHC): a widespread informal sector, general discontent with rising economic insecurity and inequality and the rollback of state and public welfare. Under such conditions, estimating the demand for a health insurance scheme (HIS) on voluntary basis can be of interest to accelerate the progress of UHC-oriented reforms. However, a major challenge that needs to be addressed in such context is related to protest attitudes that may reflect, inter alia, a null valuation of the expected utility or unexpressed demand.
Methods:
We propose to tackle this by applying a contingent valuation survey to a non-healthcare-covered Tunisian sample vis-à-vis joining and paying for a formal HIS. Our design pays particular attention to identifying the nature of the willingness-to-pay (WTP) values obtained, distinguishing genuine null values from protest values. To correct for potential selection issues arising from protest answers, we estimate an ordered-Probit-selection model and compare it with the standard Tobit and Heckman sample selection models.
Results:
Our results support the presence of self-selection and, by predicting protesters' WTP, allow the “true” sample mean WTP to be computed. This appears to be about 14% higher than the elicited mean WTP.
Conclusion:
The WTP of the poorest non-covered respondents represents about one and a half times the current contributions of the poorest formal sector enrolees, suggesting that voluntary participation in the formal HIS is feasible.

Des impacts sanitaires du changement climatique déjà bien visibles : l’exemple des canicules:Journal articleLucie Adélaïde, Olivier Chanel et Mathilde Pascal, Annales des Mines - Responsabilité et environnement, Volume 106, Issue 2, pp. 42-47, 2022

Le changement climatique, la perte de la biodiversité et l’altération globale de l’environnement détériorent la santé des populations. Plus particulièrement, l’augmentation des périodes marquées par des températures élevées et leur persistance pourraient constituer un risque majeur pour une large part de la population et limiter drastiquement l’activité humaine. Pourtant, les vagues de chaleur sont sous-représentées dans les analyses des événements météorologiques extrêmes, en particulier dans les évaluations économiques. Ce manque d’études, associé à la faible perception par la population du risque lié à la chaleur, limite la mise en place de mesures d’adaptation, alors que les effets des canicules sont en grande partie évitables. Cet article présente l’évolution de l’impact économique global des effets sanitaires des vagues de chaleur observées en France entre 1974 et 2020.

The path towards herd immunity: Predicting COVID-19 vaccination uptake through results from a stated choice study across six continentsJournal articleStephane Hess, Emily Lancsar, Petr Mariel, Jürgen Meyerhoff, Fangqing Song, Eline van den Broek-Altenburg, Olufunke A. Alaba, Gloria Amaris, Julián Arellana, Leonardo J. Basso, et al., Social Science & Medicine, Volume 298, pp. 114800, 2022

Despite unprecedented progress in developing COVID-19 vaccines, global vaccination levels needed to reach herd immunity remain a distant target, while new variants keep emerging. Obtaining near universal vaccine uptake relies on understanding and addressing vaccine resistance. Simple questions about vaccine acceptance however ignore that the vaccines being offered vary across countries and even population subgroups, and differ in terms of efficacy and side effects. By using advanced discrete choice models estimated on stated choice data collected in 18 countries/territories across six continents, we show a substantial influence of vaccine characteristics. Uptake increases if more efficacious vaccines (95% vs 60%) are offered (mean across study areas = 3.9%, range of 0.6%–8.1%) or if vaccines offer at least 12 months of protection (mean across study areas = 2.4%, range of 0.2%–5.8%), while an increase in severe side effects (from 0.001% to 0.01%) leads to reduced uptake (mean = −1.3%, range of −0.2% to −3.9%). Additionally, a large share of individuals (mean = 55.2%, range of 28%–75.8%) would delay vaccination by 3 months to obtain a more efficacious (95% vs 60%) vaccine, where this increases further if the low efficacy vaccine has a higher risk (0.01% instead of 0.001%) of severe side effects (mean = 65.9%, range of 41.4%–86.5%). Our work highlights that careful consideration of which vaccines to offer can be beneficial. In support of this, we provide an interactive tool to predict uptake in a country as a function of the vaccines being deployed, and also depending on the levels of infectiousness and severity of circulating variants of COVID-19.

Health effects from heat waves in France: an economic evaluationJournal articleLucie Adélaïde, Olivier Chanel et Mathilde Pascal, The European Journal of Health Economics, Volume 23, pp. 119–131, 2022

Background :
Scarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019.

Methods :
Health indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs.

Results :
Between 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion).

Conclusion :
The results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.

Évaluation monétaire des effets sanitaires des canicules en France métropolitaine entre 2015 et 2020Journal articleLucie Adélaïde, Olivier Chanel et Mathilde Pascal, Bulletin épidémiologique hebdomadaire, Issue 12, pp. 215-223, 2021

Bien que les canicules soient les événements climatiques extrêmes les plus importants en termes de mortalité, leurs impacts sont rarement considérés sous un angle économique. Cette méconnaissance, couplée à une perception du risque qui demeure faible, s’avère un frein à l’action en matière d’adaptation. Nous proposons une évaluation monétaire des impacts sanitaires des canicules en France métropolitaine entre 2015 et 2020.

Méthode –
Les indicateurs sanitaires suivis dans le cadre du Plan national canicule ont été utilisés pour appréhender les coûts des passages aux urgences et consultations SOS Médecins pour une sélection de causes liées à la chaleur. La mortalité en excès et la perte d’espérance de vie ont également été valorisées économiquement, ainsi que la perte de bien-être due aux restrictions d’activité. Une approche fondée sur le coût total de la maladie (coût direct, indirects et intangibles) et le consentement à payer a été utilisée.

Résultats –
Entre 2015 et 2020, les impacts sanitaires étudiés représentent au total, selon la méthode choisie, autour de 22 ou de 37 milliards €. La mortalité en excès est majoritaire (16 milliards € lorsqu’exprimée en années de vie perdues, ou 30 milliards € lorsqu’exprimée à partir des décès en excès) et la restriction d’activité est évaluée à environ 6 milliards €.

Conclusions –
Cette étude permet de mieux objectiver l’impact économique de ces événements climatiques extrêmes. Dans un contexte où les évolutions climatiques annoncent un accroissement des températures et des phénomènes de vagues de chaleur, pouvant conduire à une aggravation des impacts, ces résultats obtenus soulignent encore l’importance et l’urgence de mesures d’action permettant de renforcer l’adaptation aux canicules.

Does charity begin at home for air pollution reductions? Unraveling intra familial altruismJournal articleOlivier Chanel, Stéphane Luchini et Jason F. Shogren, Journal of Choice Modelling, Volume 38, pp. 100268, 2021

We propose a structural econometric model that incorporates altruism towards other household members into the willingness to pay for a public good. The model distinguishes preferences for public good improvements for oneself from preferences for improvements for other household members. We test for three different types of altruism - ‘pure self-interest’, ‘pure altruism’ and ‘public-good-focused non-pure altruism’. Using French contingent valuation data regarding air quality improvements, we find positive and significant degrees of concern for children under the age of 18, which are explained by determinants related to health and subjective air quality assessment. All other forms of pure or air-quality-focused altruism within the family are insignificant, including for children over 18, siblings, spouses, and parents. This result suggests that benefit estimates that do not consider altruism could undervalue improvements in air quality in France.

Évaluation économique de la mortalité liée à la pollution atmosphérique en FranceJournal articleOlivier Chanel, Sylvia Medina et Mathilde Pascal, Journal de gestion et d'Economie de la santé, Volume 38, Issue 2, pp. 77-92, 2020

Cet article propose une discussion méthodologique à partir d’une évaluation économique des impacts sur la mortalité de l’exposition chronique aux particules fines en France continentale. Il prend comme point de départ l’évaluation quantitative d’impact sanitaire (EQIS), réalisée par Santé publique France en 2016, de 5 scénarios de réduction des concentrations par deux méthodes de mesure de la mortalité (nombre de décès prématurés évités et nombre total d’années de vie gagnées). Après une justification des valeurs monétaires utilisées – 3 millions € pour la valeur d’évitement d’un décès et 80 000 € pour celle d’une année de vie gagnée – nous les appliquons aux données sanitaires, et obtenons des résultats comparables aux études contemporaines. En particulier, dans un scénario sans pollution anthropique, l’EQIS de 2016 estime à 48 283 les décès prématurés évités, que nous évaluons à 144,85 milliards €2008. Nous questionnons ensuite les méthodes et pratiques, en commençant par identifier les sources de divergence avec la précédente étude française menée en 1998-99, dont l’évaluation était 5 fois moindre en dépit d’émissions particulaires plus élevées. Puis, nous discutons le choix des valeurs monétaires et les conditions d’utilisation de ces résultats dans la décision publique. Au final, nous apportons un argument supplémentaire sur la nécessité de réduire l’exposition des populations à la pollution de l’air ambiant en France.

Air Pollution and Health: Economic ImplicationsBook chapterOlivier Chanel, In: Handbook of Labor, Human Resources and Population Economics, Klaus F. Zimmermann (Eds.), 2020, pp. 1-42, Springer International Publishing, 2020

In September 2021, the World Health Organization decided to implement stronger air quality guidelines for protecting health, based on the last decade of research. Ambient air pollution (AAP) was already the first environmental risk to health in terms of number of premature deaths, and this decision suggests that the risk was seriously underestimated. This chapter covers the relationship between AAP and health from an economic perspective. The first part presents the major regulated air pollutants and their related health effects, the way population exposure is measured, and the individual vulnerability and susceptibility to AAP-related effects. Then, the main approaches that estimate the relationships between health effects and air pollutants are covered: pure observational and interventional/quasi-experimental studies. Up-to-date reviews of the most robust relationships, and of the main findings of interventional/causal inference methods, are detailed. Next, impact assessments studies are tackled and some recent global assessments of health impacts due to AAP are presented. Once calculated, the health impacts can be expressed in monetary terms to enter the decision-making process. The relevant approaches for valuing market and nonmarket health impacts – market prices, revealed and stated preferences – are critically outlined, and their adequation with the AAP context examined. Finally, the economic health-related impacts of AAP are presented and discussed, with specific sections devoted to the necessity of an interdisciplinary approach and inequity-related issues at national and international levels. This chapter concludes with a widening of the perspective that tackles interactions between AAP on the one hand and climate change and indoor pollution on the other hand.

When do social cues and scientific information affect stated preferences? Insights from an experiment on air pollutionJournal articleDominique Ami, Frédéric Aprahamian, Olivier Chanel et Stéphane Luchini, Journal of Choice Modelling, Volume 29, Issue C, pp. 33-46, 2018

Stated preference surveys are usually carried out in one session, without any follow-up interview after respondents have had the opportunity to experience the public goods or policies they were asked to value. Consequently, a stated preference survey needs to be designed so as to provide respondents with all the relevant information, and to help them process this information so they can perform the valuation exercise properly. In this paper, we study experimentally an elicitation procedure in which respondents are provided with a sequence of different types of information (social cues and objective information) that allows them to sequentially revise their willingness-to-pay (WTP) values. Our experiment was carried out in large groups using an electronic voting system which allows us to construct social cues in real time. To analyse the data, we developed an anchoring-type structural model that allows us to estimate the direct effect (at the current round) and the indirect effect (on subsequent rounds) of information. Our results shed new light on the interacted effect of social cues and objective information: social cues have little or no direct effect on WTP values but they have a strong indirect effect on how respondents process scientific information. Social cues have the most noticeable effect on respondents who initially report a WTP below the group average but only after receiving additional objective information about the valuation task. We suggest that the construction and the provision of social cues should be added to the list of tools and controls for stated preference methods.

Reducing the anchoring bias in multiple question CV surveysJournal articleVictor Champonnois, Olivier Chanel et Khaled Makhloufi, Journal of Choice Modelling, Volume 28, Issue C, pp. 1-9, 2018

The elicitation format is a crucial aspect of Contingent Valuation (CV) surveys and can impact their reliability. This paper contributes to the extensive debate on WTP (Willingness To Pay) elicitation formats by assessing whether the Circular Payment Card (CPC) can reduce anchoring on respondents' previous answers under multiple elicitation questions. This new format 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 WTP. We used a CV survey based on two ways of reducing risks associated with flooding, each randomly presented first to half of the respondents, to test the absolute performance of CPC. We presented a second survey on two social insurance schemes for subjects currently uninsured to respondents randomly split into three subgroups. Each group's WTP was elicited using one of three formats: Open-Ended (OE), standard Payment Card (PC) and the new CPC. The two insurance schemes were always proposed in the same order, and we assessed the relative performance of CPC by comparing anchoring across respondents. Our results provide evidence that CPC is likely to reduce anchoring in multiple elicitation questions and that respondents may rely on different heuristic decisions when giving WTP in the OE and in the two PC formats.