Melikov K, Alekperov R, Ibrahimova J, Aliyeva F; International Conference on AIDS.

Int Conf AIDS. 2000 Jul 9-14; 13: abstract no. TuPeD3621.

K.Melikov, UNFPA, 3, UN 50th Anniversary Street, Baku 370001, Azerbaijan, Tel.: +994 12 922 441, E-mail: kmelikov@yahoo.com

Background: Introduction of user fees to raise resources for health care in low and middle income countries has affected the pattern of health services consumption in these countries. This study is aiming to estimate the impact of user fees on STD related diagnostic services consumption in one low income country; to describe costs and outcomes of STD related diagnostic services in order to predict changes in demand for STD diagnostic services under different pricing policies; and to estimate possible impact of introduction of Syndromic approach on demand for STD diagnostic services.Methods: Willingness-to-pay method in "take-it-or-leave-it" modification has been employed to elicit value of STD diagnostic services for women of reproductive age residing (WRAG) in Baku city. Multivariate logistic modeling was used to control social-economical characteristics of population under the study (age, education, income level, and number of children) and to calculate probability of willingness-to-pay at different bidding level. A bid curve for STD diagnostic services has been elaborated and mean and median willingness-to-pay for mentioned services has been calculated from the survey responses. Direct allocation of overhead costs and working time unit as proxy of workload measurement unit has been used to describe costs of STD diagnostic services in Republic Family Planning Consultation.Results: 500 bidding responses for 7 bidding amounts were obtained. Participation rate was 67.3%. Average age of respondents was 33.6 years with confidence interval 32.8 - 34.3 years and variation 17 - 45. Distribution of social-economic characteristics of study population was similar to that of resident population of WRAG in Baku city. STD diagnostic services provided in the facility under the study included: family planning counseling; first visit to gynecologist; vaginal mount; vaginal mount with dyeing for Chlamidia; urethra mount; blood test for Chlamidia; RW test; blood test for Herpes; and trans-abdominal US investigation of reproductive organs. The costs of this set of services was at 101,582 manats (25.4 US dollars), while the overall price charged at the same facility for described services was at 151,000 manats ($37.75). Mean willingness-to-pay for STD diagnostic services in overall study population were 115,903 manats ($30) and median willingness-to-pay in overall study population was 152,691 manats ($38.2). Stratification by income groups yielded the following results: mean and median willingness to pay for STD diagnostic services in very poor income group (monthly income less than $30 WB Azerbaijan) was respectively 114,277 manats ($28.6) and 135,891 manats ($34). For poor income group (monthly income between $30 and $70, WB Azerbaijan) mean and median WTP was 121,256 manats ($30.3) and 180,602 manats ($45.15) respectively and for above poverty level income group 109,935 manats ($27.5) and 138,240 ($34.6). Analysis of price elasticity of willingness-to-pay indicates that at current price level for STD diagnostic services this indicator is close to unitary and equal to -0.98. For very poor and above poverty income groups price elasticity of willingness-to-pay is above 1 (-1.06 and -1.27 respectively, and demand is elastic), for poor income group demand expressed by willingness-to-pay is inelastic (-0.72).Conclusions: 1) STD diagnostic services provision is cost-efficient and yields $1.33 for each $1 invested, though high costs of traditional approach to STD management might be considered as on of the factors limiting access of population to these services. 2) Current price charged at Republic Family Planning consultation for STD diagnostic services is approximately at the level of median willingness to pay for these services for overall study population, though in very poor income group only 0.45 probability of willingness-to-pay this price were found. 3) Demand for STD diagnostic services expressed through willingness-to-pay was elastic for very poor income group of population and close to unitary in overall study population. Implication of this finding is that increasing price in case of profit maximizer would increase slightly revenue, however demand of very poor income group would shrink considerably. 4) Reducing charges for STD diagnostic services down to cost level may increase patient flow for STD diagnostic services by 34%. In case of syndromic approach for STD management with its potency to reduce costs of STD diagnosis considerably possible increase of clients for STD diagnosis is expected to be much higher.

Publication Types:

• Meeting Abstracts

Keywords:

• Azerbaijan
• Child
• Commerce
• Data Collection
• Diagnostic Services
• Family Planning Services
• Fees and Charges
• Female
• Humans
• Income
• Population Groups
• Poverty
• Research
• economics
• organization & administration

Other ID:

• GWAIDS0002184

UI: 102239677

From Meeting Abstracts