http://repub.eur.nl/res/aut/13919/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/21078/ 2010-10-01T00:00:00Z Abstract Demographic and cultural changes have given rise to the question of whether adult children will continue to provide support to their elderly parents. In a qualitative study among selected respondents from a large representative sample, we investigated the motivations of adult children to provide support to their elderly parents. Five major themes emerged: Individual choice, obligation, reciprocity, quality of the relationship and genetic relatedness. Respondents rejected general norms of filial obligations, were reluctant to impose behavioral rules on others, but nevertheless expressed strong personal obligations to care. Individualization is often equated with withdrawing from providing care. Our findings suggest otherwise. Filial obligations tend to be strong, but personalized. Social prescriptions have given way to personal motives to provide care. http://repub.eur.nl/res/pub/20725/ 2010-06-01T00:00:00Z Objectives: In economic evaluations future health and monetary outcomes are commonly discounted at equal and constant rates. The theoretical foundation of this practice is being debated and appropriate discount rates for costs and health effects are sought. Here, we have derived social discount rates for health, money, and environmental benefits by means of a choice experiment. Methods: All choices were framed from a social perspective. We investigated differences in time preference by domain (health, monetary benefits, environmental benefits), time delay (5, 10, and 40 years), and respondent characteristics. Respondents were 173 health-care professionals and 34 health policymakers. Choice titration was used to determine when the respondent was indifferent between future and present benefits. Results: At least two-thirds of respondents preferred an intervention with immediate benefits to delayed benefits in the different domains. The median (mean) yearly discount rates for health benefits were 2.7% (10.7%), 1.3% (3.5%), and 1.1% (2.3%) assuming a 5, 10, and 40 years delay, respectively. Social time preference for monetary benefits was significantly stronger, with median (mean) yearly discount rates of 6.6% (18.7%) and 4.8% (11.2%) assuming a 5 and 10 years delay, respectively. The social time preference with regard to environmental benefits was similar to the monetary benefits. Social time preference for the different domains was significantly correlated at the individual level. Conclusions: The empirically derived social time preference is in line with current theoretical arguments for a lower discount rate for health benefits than for monetary benefits. Moreover, the implied median discount rates for health were lower than those commonly used or advocated in guidelines. http://repub.eur.nl/res/pub/19608/ 2010-01-01T00:00:00Z Abstract Demographic and cultural changes have given rise to the question of whether adult children will continue to provide support to their elderly parents. In a qualitative study among selected respondents from a large representative sample, we investigated the motivations of adult children to provide support to their elderly parents. Five major themes emerged: Individual choice, obligation, reciprocity, quality of the relationship and genetic relatedness. Respondents rejected general norms of filial obligations, were reluctant to impose behavioral rules on others, but nevertheless expressed strong personal obligations to care. Individualization is often equated with withdrawing from providing care. Our findings suggest otherwise. Filial obligations tend to be strong, but personalized. Social prescriptions have given way to personal motives to provide care. http://repub.eur.nl/res/pub/18080/ 2008-04-01T00:00:00Z There is considerable debate about the effects of today's family structures on support arrangements for older people. Using representative data from The Netherlands, the study reported in this paper investigates which socio-demographic characteristics of adult children and their elderly parents, and which motivations of the adult children, correlate with children giving practical and social support to their parents. The findings indicate that the strongest socio-demographic correlates of a higher likelihood of giving support were: having few siblings, having a widowed parent without a new partner and, for practical support, a short geographical distance between the parent's and child's homes. Single mothers were more likely to receive support than mothers with partners, irrespective of whether their situation followed divorce or widowhood. Widowed fathers also received more support, but only with housework. A good parent-child relationship was the most important motivator for giving support, whereas subscribing to filial obligation norms was a much weaker motivator, especially for social support. Insofar as demographic and cultural changes in family structures predict a lower likelihood of support from children to elderly parents, this applies to practical support, and derives mainly from increased geographical separation distances and from the growing trend for parents to take new partners. Social support is unlikely to be affected by these changes if parents and children maintain good relationships. http://repub.eur.nl/res/pub/36912/ 2007-05-23T00:00:00Z Background. The effects of socio-demographic characteristics of the respondent, including age, on valuation scores of hypothetical health states remain inconclusive. Therefore, we analyzed data from a study designed to discriminate between the effects of respondents' age and time preference on valuations of health states to gain insight in the contribution of individual response patterns to the variance in valuation scores. Methods. A total of 212 respondents from three age groups valued the same six hypothetical health states using three different methods: a Visual Analogue Scale (VAS) and two variants of the Time trade-off (TTO). Analyses included a generalizability study, principal components analysis, and cluster analysis. Results. Valuation scores differed significantly, but not systematically, between valuation methods. A total of 36.8% of variance was explained by health states, 1.6% by the elicitation method, and 0.2% by age group. Individual differences in the use of the response scales (e.g. a tendency to give either high or low TTO scores, or a high or low scoring tendency on the VAS) were the main source of remaining variance. These response patterns were not related to age or other identifiable respondent characteristics. Conclusion. Individual response patterns in this study were more important determinants of TTO or VAS valuations of health states than age or other respondent characteristics measured. Further valuation research should focus on explaining individual response patterns as a possible key to understanding the determinants of health state valuations. http://repub.eur.nl/res/pub/10787/ 2007-01-01T00:00:00Z ABSTRACT: BACKGROUND: The literature remains inconclusive about the effects of socio-demographic characteristics of the respondent, including age, on valuation scores of hypothetical health states. We analyzed data from a study designed to discriminate between the effects of respondents age and time preference on valuations of health states to get insight in the contribution of individual response patterns to the variance in valuation scores. METHODS: 212 respondents from different age groups valued six hypothetical health states with three methods: a Visual Analogue Scale (VAS) and two variants of the Time trade-off (TTO). Analyses included a generalizability study, principal components analysis and cluster analysis. RESULTS: Valuation scores differed significantly but not systematically between valuation methods. A total of 36.8% of variance was explained by health states, 1.6% by elicitation method and 0.2% by age group. Individual differences in the use of the response scales, e.g. a tendency to give either high or low TTO-scores, or a high or low scoring tendency on the VAS were the main source of remaining variance. These response patterns were not related to age or other identifiable respondent characteristics. CONCLUSIONS: We conclude that individual response patterns were more important determinants of TTO or VAS valuations of health states than age or other measured respondent characteristics. Further valuation research should focus on explaining individual response patterns as a possible key to understanding the determinants of health state valuations.