Willingness to Pay for Community-Based Care Programmes for Older People in Ireland
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Non-market valuation techniques are employed across a range of economic disciplines to assess the economic value generated by goods and services that typically are not captured by traditional market price mechanisms. Such methods and analysis may then also be utilised to inform public policy and resource allocation management decisions. This thesis aims to establish the economic value that the Irish population place on five different community-based care programmes that support older people to continue living at home, thereby offering key information to the long-term care policy debate. Drawing on a theoretical foundation of constrained utility maximisation theory, preferences are examined through the application of a willingness-to-pay (WTP) contingent valuation survey issued to a representative sample of the Irish population. The various community care programmes included for valuation covered traditional forms of community care provision through to innovative technology-based measures, allowing a comparison of the strength and direction of preferences for different methods of community care provision. Particularly, this thesis establishes the value placed on the innovative technology based methods targeting particular care needs and enhancing our understanding of the role of technology within the Irish community care model. Furthermore, the survey-based methodology employed also provided a platform for the exploration of various design biases associated with the contingent valuation survey methodology, including preference elicitation question sequencing, ordering effects and preference uncertainty. The first section of this thesis contextualises health and social care for older people in Ireland, establishing the current models of community based care and the role of technology within the Irish social care system. Given the nature of community care as an economic good, which falls beyond the scope of traditional market price mechanisms, the Contingent Valuation Method (CVM) is chosen to estimate the economic value of the various interventions. This section also outlines the survey design process, pre-testing methods and pilot findings. The second section of this thesis provides an in-depth exploratory analysis of the results from the preference elicitation methods employed in the CVM survey, namely explicit rankings and implicit WTP estimates. A detailed exploration of WTP disaggregated per sample as well as across a range of socio-economic characteristics is presented. Rationality tests using Sen¿s expansion property within the explicit rankings and the influence of socio-economic characteristics on ranking results are also explored. Given the high percentage of zero responses within the survey results, various corner solution models are compared in estimating the bid function and the model results are discussed per sample with policy implications investigated. Subsequently, the results of the methodological design tests, including ordering effects, a behavioural exploration of preference certainty and the impact of the question order of the elicitation methods on welfare estimates are presented in detail and the survey design repercussions are discussed. The work shows that citizens value community care programmes for older people in Ireland. Family care is the most preferred option based on rankings and WTP estimates. People also valued technology in community care but less so than either family care or conventional state care. In relation to technology care, people valued the social connection technology programme more than either a falls prevention or cognitive detection technology programme.
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