Willingness to pay and the sensitivity of willingness to pay for interdisciplinary musculoskeletal clinics: a contingent valuation study in Quebec, Canada.

Orthopedics is a discipline that requires a continuum of care in close collaboration with physicians, nurses, and healthcare professionals to ensure effective rehabilitation. In some cases, the wait time for a consultation may be very long, which can jeopardize the patient's rehabilitation and sometimes even cause complications that lead to a loss of autonomy. In Quebec, there is a severe shortage of healthcare professionals-and of orthopedic surgeons, in particular-specializing in musculoskeletal problems. To address this problem, public managers have decided to establish interdisciplinary musculoskeletal clinics in regions outside the two major cities of Montréal and Québec. The major benefits of these clinics are that they reduce the wait time for consultation and treatment while maintaining service quality. Although their benefits are certain, these clinics remain threatened by relatively high initial costs. This study's objective is to evaluate whether the population of Quebec has a quantifiable willingness to pay (WTP) to establish these clinics. To our knowledge, this is the first study of its kind either in the province of Quebec or elsewhere. We selected 3822 subjects randomly within the target population using Internet surveys, telephone surveys and self-administered paper surveys as our methods of recruitment. Three payment vehicles were used and each participant was randomly allocated among these: tax, donation or lump-sum fee. A contingent valuation question using a referendum format with the option "don't know" was used. Econometric estimates were performed using probit and Wang's models. Our results indicate that the population of Quebec may potentially have a mean WTP of 42.3 Canadian dollars per person for such clinics, which would enable a mean reduction from 12 to 4 months of wait time. However, the WTP is found to be very sensitive to the survey mode and the payment vehicle used: about 1.2-2 times more important in the tax and the lump-sum fee scenarios than in the donation scenario, and about 3-4 times less important in the Internet survey than in the telephone or self-administered paper surveys. In addition, this amount was strongly affected by the introduction of a new governmental health-related policy that arose during the survey and led to a minimal drop in WTP of about 30-50 %. This strong sensitivity led us to the three following recommendations for future contingent valuation studies: (1) favour Internet surveys, (2) use a payment vehicle that limit uncertainty in the WTP answer and allow to socialize benefits, as the tax scenario in our study, and (3) strictly apply the "divide by 2" rule of the NOAA panel.