Determining the economic value of pharmacist services: A study of the reliability and validity of contingent valuation methods

Abstract

The intent of this study is to understand the extent to which consumers' are willing to pay to have access to community-based pharmacist services. These services are distinct from the physical skills of dispensing a pharmaceutical product. The contingent valuation method was used to determine consumers' willingness-to-pay (WTP) for these services. Contingent valuation is a survey method that asks individuals to express their WTP for a good or service currently not available and/or not priced in well-functioning markets. A convenience sample of 348 adult, working individuals from four locations around Baltimore city were asked their WTP for five individual pharmacist services and then for a package of all services in hypothetical market scenarios. Consumers were asked their WTP via three payment mechanisms: an out-of-pocket payment, a monthly insurance premium and an annual membership fee payable to a pharmacy of their choice. The survey was administered using a self-administered, computerized interview to obtain WTP bids in dollar terms for community-based pharmacist services. All WTP values for pharmacist services are significantly greater than zero. A two-part estimation model that corrects for the biased estimates of zero dollar bidders, was used to separate WTP bidding behavior into two stages. The first stage separates individuals by their decision to bid for pharmacist services and then a decision about how much to bid conditional on bidding in the first place. The probability of bidding ranged from 0.595 for advice on nonprescription medication to 0.837 for the pharmacists attention to safety when dispensing a prescription medication. Respondents were WTP most to have the pharmacist review the appropriateness of all their medication ($4.76, SD 5.90) and to have all pharmacist services available based on an annual fee ($89.14, SD 161.37). Individuals are more likely to bid if they are non-white and have a positive attitude towards paying and are less likely to bid if they have an income exceeding $50,000/year. Non-whites are WTP significantly more than whites. Tests of starting point bias and the effect of information on WTP bids were not significant. The WTP bids obtained for community-based pharmacist services are subject to rational interpretation.