Thèse soutenue

Les apports de la méthode de l'évaluation contingente aux réformes des systèmes de santé des pays en développement : le cas de la Palestine
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Auteur / Autrice : Awad Mataria
Direction : Jean-Paul Moatti
Type : Thèse de doctorat
Discipline(s) : Sciences économiques
Date : Soutenance en 2004
Etablissement(s) : Aix-Marseille 2

Résumé

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This Thesis aims to help establish a complementary funding mechanism for health services in the context of the current socioeconomic crisis in the emerging Palestinian State. It focuses on the design of an efficient and equitable cost-recovery mechanism for primary health care services, based on the value of improving the quality of care from the patients' perspective. The study makes use of contingent valuation method to assess the value, for the patients, of improving the quality of care, by eliciting patients' willingness to pay values for the different quality improvements. A contingnent valuation questionnaire was designed based on a decomposed valuation scenario and the payment card elicitation technique, with user-based financial contributions at the point of consumption being the payment vehicle. The questionnaire was administered on a sample of patients seeking care in different primary health care centers in Ramallah district during summer 2001. The elicited values were used to inform decision-makers about the highest extra user fee patients would be willing to pay to benefit from specified improvements in the quality of care. The values were used to model the demand function for improved care and to estimate demand price-elasticity and the impact of changing the pricing structure on centers' revenues. The questionnaire was re-administered 19 months later to detect the impact of the explosion of the second Palestinian Intifada and the concomitent steep impoverishment of the Palestinian population on patients' willingness and ability to pay for health care. The results demonstrate the feasibility and the “good” validity of contingent valuation when applied to developing countries. Increasing user fees seems to have a negative impact on demand for health care with price-elasticity increasing with rising user fees. An optimal user fee level could be attained to maximize centers' revenues; however, this would be accompanied with catastrophic social consequences. The study recommends suspending and attempt to put more burden on the patients in the present context, where poverty could adversly affect patients' ability to properly express their prefereces.