Background: Tooth loss has a negative impact on patients’ general health and wellbeing. Dental prostheses can restore oral function, aesthetics and improve oral health related quality of life. Preferences for dental prostheses cannot be fully captured using existing clinical studies and questionnaires. Discrete choice experiment (DCE) is a novel method in health economics to elicit people’s preference for treatments and it allows the researcher to integrate all aspects relevant to treatment into evaluation and measurement of interrelationship between factors. The aim of this PhD thesis is to use a mixed method of DCE and qualitative interviews to analyse dentists and patient’s preferences for dental prosthesis choices in replacing missing teeth. Methods: Discrete choice experiment questionnaires were developed, describing dental prosthdontic treatments in multi-dimensions, including outcome, process and economic factors. Survey and analysis using the questionnaires were conducted with dentists and patients in Edinburgh. Qualitative interviews with Edinburgh dentists and patients were carried out to derive factors to aid the DCE questionnaire design and provide in-depth understanding of DCE results. Systematic reviews were performed to summarise existing evidence on prosthesis evaluation in traditional quantitative studies and perception of prostheses in qualitative interviews. The current application of DCEs in dentistry was also systematically reviewed. Results: Treatment longevity was identified as the most important factor for dentists and patients’ treatment decisions of anterior missing tooth replacements, followed by appearance and chewing function. Dentists put more value on fixation/comfort and treatment procedure than patients. Patients cared about cost of treatment whereas dentists were relatively insensitive. Gender, age and treatment experience significantly influenced patients’ preference for treatment characteristics. Dental implant supported crown was preferred by dentists, whereas patients gave higher utility to traditional prosthodontic treatments. The monetary benefit of fixed dental prostheses ranged from £1856 -£3848 for patients, far exceeding their willingness-to-pay (WTP), which was £120 - £240. Dentists were willing to pay £600-£3000, more than the perceived benefit £503 to £1649. Qualitative study identified the above factors and provided interpretation of DCE results. Problems in the dental care system related to referral and training for dental implant treatments were raised. Discussion: This thesis is the first DCE application in dentistry evaluating and comparing dentists and patients preferences for missing tooth replacements. Dentists and patients’ preferences were elicited qualitatively and qualitatively integrating multidimensional factors. Patients’ preference for treatments, monetary benefit and WTP were demonstrated to be different from dentists’. Treatment benefits exceeded patients WTP for fixed dental prostheses.

Discrete choice experiments (DCEs) are a stated preference valuation method. As a ubiquitous component of healthcare delivery, risk is increasingly used as an attribute in DCEs. Risk is a complex concept that is open to misinterpretation; potentially undermining the robustness of DCEs as a valuation method. This thesis employed quantitative, qualitative and eye-tracking methods to understand if and how risk communication formats affected individuals’ choices when completing a DCE and the valuations derived. This thesis used a case study focussing on the elicitation of women’s preferences for a national breast screening programme. Breast screening was chosen because of its relevance to primary care and potential contribution to the ongoing debate about the benefits and harms of mammograms. A DCE containing three attributes (probability of detecting a cancer; risk of unnecessary follow-up; and cost of screening) was designed. Women were randomised to one of two risk communication formats: i) percentages only; or ii) icon arrays and percentages (identified from a structured review of risk communication literature in health).Traditional quantitative analysis of the discrete choices made by 1,000 women recruited via an internet panel revealed the risk communication format made no difference in terms of either preferences or the consistency of choices. However, latent class analysis indicated that women’s preferences for breast screening were highly heterogeneous; with some women acquiring large non-health benefits from screening, regardless of the risks, and others expressing complete intolerance for unnecessary follow-ups, regardless of the benefits. The think-aloud method, identified as a potential method from a systematic review of qualitative research alongside DCEs, was used to reveal more about DCE respondents’ decision-making. Nineteen face-to-face cognitive interviews identified that respondents felt more engaged with the task when risk was presented with an additional icon array. Eye-tracking methods were used to understand respondents’ choice making behaviour and attention to attributes. The method was successfully used alongside a DCE and provided valid data. The results of the eye-tracking study found attributes were visually attended to by respondents most of the time. For researchers seeking to use DCEs for eliciting individuals’ preferences for benefit-risk trade-offs, respondents were more receptive to risk communicated via an icon array suggesting this format is preferable. Policy-makers should acknowledge preference heterogeneity, and its drivers, in their appraisal of the benefits of breast screening programmes. Future research is required to test alternative risk communication formats and explore the robustness of eye-tracking and qualitative research methods alongside DCEs.

Natural disasters are increasing in frequency and intensity and have devastating impacts on individuals, both humanitarian and economic, particularly in developing countries. Microinsurance is seen as one promising instrument of disaster risk management, however the level of demand for respective projects remains low. Using behavioural games and a discrete choice experiment, this paper analyses the demand for hypothetical microinsurance products in rural Cambodia and contributes significant household level evidence to the current research. A general preference for microinsurance can be found, with demand significantly affected by price, provider, requirements for prevention and combinations with credit. Furthermore, financial literacy, risk aversion, levels of trust and previous disaster experience impact the individual demand for flood insurance in rural Cambodia.

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The growing interest among consumers in the link between diet and health makes functional food one of the fastest growing sectors in the global food industry, especially functional dairy products. Understanding consumer choices with respect to functional food is an important and relatively new research area. Given the credence nature of functional food attributes, labelling plays a key role in allowing consumers to make informed choices about foods with enhanced health attributes. In 2007, Canada launched a review of the regulatory system for health claims on functional foods, which included rules concerning the approval, labelling and verification of health claims. In 2010 two new health claims related to oat products and plant sterols were approved by Health Canada. An analysis of how consumers respond to health claim information is therefore timely. This thesis focuses on examining the effects of different types of labelling and verification of health claims on consumers stated preferences for a specific functional food product, Omega-3 milk. The analysis incorporates reference-dependent effects. This study improves the knowledge of Canadian consumer understanding of health claims and the impact of health claims on consumer choice. This research is one of the first studies to simultaneously examine the effects of different types of health claims (e.g. function claims, risk reduction claims and disease prevention claims) and other ways of signalling or implying health benefits (e.g. symbols) on Canadian consumers' functional food choices. This study contributes to the knowledge in this domain by providing a comparative analysis of different types of labelling strategies. The extant knowledge of labelling effects in the formats of risk reduction claims, disease prevention claims and symbols or imagery on functional foods is limited. One of the primary contributions of this study is addressing this gap in the literature. The theoretical framework of this thesis is based on random utility theory. A stated preference choice experiment is designed to examine consumers' response to Omega-3 milk under different labelling scenarios. Using data from an online survey of 740 Canadians conducted in summer 2009, discrete choice models, including Conditional Logit, Random Parameter Logit and Latent Class models, and Willingness-To-Pay (WTP) values are estimated. The results suggest that full labelling (function claims, risk reduction claims and disease prevention claims) is preferred over partial labelling (e.g. the use of a heart symbol to imply a health claim), but primarily for risk reduction claims. There is no significant difference between a function claim, such as "good for your heart" and partial labelling in the form of a red heart symbol. The results also suggest that consumers on average respond positively to verification of health claims by government and the third party agencies, however, the Latent Class models reveal considerable heterogeneity in consumer attitudes toward the source of verification. The influences of key-socio-demographic (e.g. income, education and health status) and attitudinal factors (e.g. attitude, trust and knowledge) provide further insights into consumer responses in the choice experiment to identify different consumer segments. Moreover, the results reveal reference-dependent effects where perceived losses of ingredient or price attributes have a greater influence on consumer choice than perceived gains. In terms of industry and public policy implications, this study suggests that food manufacturers in Canada would benefit from the ability to make more precise health claims. The implications derived from the Latent Class Models could help the Canadian functional food industry to identify target consumer segments with different characteristics for the purpose of developing marketing strategies. Furthermore, the results of this study suggest that Canadian consumers are receptive to both full labelling and partial labelling. It indicates that public policy makers need to pay attention to effectively regulating health claims for functional foods so as to balance the need for credible health claims to facilitate the development of the functional food sector with the imperative of protecting consumers from misleading health claims. Public policy makers should also be aware that the verification of health claims plays an important role in reducing consumers' uncertainty and making health claims more credible.

The growing interest among consumers in the link between diet and health makes functional food one of the fastest growing sectors in the global food industry, especially functional dairy products. Understanding consumer choices with respect to functional food is an important and relatively new research area. Given the credence nature of functional food attributes, labelling plays a key role in allowing consumers to make informed choices about foods with enhanced health attributes. In 2007, Canada launched a review of the regulatory system for health claims on functional foods, which included rules concerning the approval, labelling and verification of health claims. In 2010 two new health claims related to oat products and plant sterols were approved by Health Canada. An analysis of how consumers respond to health claim information is therefore timely. This thesis focuses on examining the effects of different types of labelling and verification of health claims on consumers stated preferences for a specific functional food product, Omega-3 milk. The analysis incorporates reference-dependent effects. This study improves the knowledge of Canadian consumer understanding of health claims and the impact of health claims on consumer choice. This research is one of the first studies to simultaneously examine the effects of different types of health claims (e.g. function claims, risk reduction claims and disease prevention claims) and other ways of signalling or implying health benefits (e.g. symbols) on Canadian consumers' functional food choices. This study contributes to the knowledge in this domain by providing a comparative analysis of different types of labelling strategies. The extant knowledge of labelling effects in the formats of risk reduction claims, disease prevention claims and symbols or imagery on functional foods is limited. One of the primary contributions of this study is addressing this gap in the literature. The theoretical framework of this thesis is based on random utility theory. A stated preference choice experiment is designed to examine consumers' response to Omega-3 milk under different labelling scenarios. Using data from an online survey of 740 Canadians conducted in summer 2009, discrete choice models, including Conditional Logit, Random Parameter Logit and Latent Class models, and Willingness-To-Pay (WTP) values are estimated. The results suggest that full labelling (function claims, risk reduction claims and disease prevention claims) is preferred over partial labelling (e.g. the use of a heart symbol to imply a health claim), but primarily for risk reduction claims. There is no significant difference between a function claim, such as "good for your heart" and partial labelling in the form of a red heart symbol. The results also suggest that consumers on average respond positively to verification of health claims by government and the third party agencies, however, the Latent Class models reveal considerable heterogeneity in consumer attitudes toward the source of verification. The influences of key-socio-demographic (e.g. income, education and health status) and attitudinal factors (e.g. attitude, trust and knowledge) provide further insights into consumer responses in the choice experiment to identify different consumer segments. Moreover, the results reveal reference-dependent effects where perceived losses of ingredient or price attributes have a greater influence on consumer choice than perceived gains. In terms of industry and public policy implications, this study suggests that food manufacturers in Canada would benefit from the ability to make more precise health claims. The implications derived from the Latent Class Models could help the Canadian functional food industry to identify target consumer segments with different characteristics for the purpose of developing marketing strategies. Furthermore, the results of this study suggest that Canadian consumers are receptive to both full labelling and partial labelling. It indicates that public policy makers need to pay attention to effectively regulating health claims for functional foods so as to balance the need for credible health claims to facilitate the development of the functional food sector with the imperative of protecting consumers from misleading health claims. Public policy makers should also be aware that the verification of health claims plays an important role in reducing consumers' uncertainty and making health claims more credible.

Hawaii’s pristine ocean and tropical environment is a keystone of Hawaii tourism and the state economy. Water pollution from stormwater and development threatens the beach quality to both residents and tourists. In order to understand the lost nonmarket value, we assess changes in quality of beach characteristics including water and sand quality, swimming safety conditions, and congestion using a Discrete Choice Experiment of recreational beach users. Further, we study willingness to pay (WTP) for water management strategies in Hawaii using another discrete choice experiment, including structural and nonstructural Best Management Practices, testing, monitoring, and educational efforts. Using a mixed logit model, beach quality results suggest similar preferences among resident and tourists. Both groups consistently have higher WTP to avoid poor quality levels versus obtaining excellent levels. Additionally, water quality is the single most important attribute. For the policy discrete choice experiment, both parties exhibit similar ranking of WTP to initiate water quality management strategies, with improved testing methods followed by education having the highest WTP. Lastly, we use Benefit-Cost analysis to find that all significant management strategies may be viable, since WTP is greater than the predicted cost of implementation based on expert opinion of Hawaiian policy leaders.

THE AUSTRALIAN HEALTH CARE SYSTEM has an overarching objective to improve the well-being of all Australians in an equitable and efficient manner. But like most developed economy health care systems, it has experienced a continual increase in demand for health care services along with increased pressure to improve efficiency, quality, and sustainability. To assist in health sector management, policy formulation, investment decisions and reform, the Australian government developed the National Health Performance Framework (NHPF). The NHPF employs performance indicators across nine dimensions of health care, including Effectiveness, Appropriateness, Efficiency, Responsiveness, Accessibility, Safety, Continuity, Capability, and Sustainability. While the National Health Performance Committee has recognised that performance indicators used within the NHPF are inadequate, this thesis argues that the solution is not a simple matter of collecting additional data and constructing new and ???improved??? indicators. Due to resource constraints within the health care system there is an implicit performance trade-off across dimensions. The NHPF must take into consideration the value individuals place on the health care dimensions to enable a shift of limited resources to those areas that are most valued. The starting point for the NHPF should be to determine what society wants out of a health system. The purpose of this thesis is to determine Australian society???s preferences for performance across the nine NHPF dimensions of health care. This is achieved using a choice modelling experiment, which describes the performance of the current health care system and alternative health care systems the government could work towards, and asks respondents to compare and choose which system they prefer. A mixed multinomial logit model is used to analyse respondent choices in order to incorporate alternative tastes across attributes, and correlation of tastes across alternatives and scenarios. Relative values attached to the nine NHPF dimensions of health care are calculated and preferences for the dimensions are ranked. The thesis concludes by exploring individual preferences derived form the choice modelling experiment in the context of social welfare theory. It also outlines the strengths and weaknesses of the methodology, provides suggestions for further research, and offers a use for social preferences in the development of performance frameworks within the Australian health care system.

Background: Well-being within this thesis is defined as the multidimensional quality of a person’s life, which can be broken down into ‘subjective’ and ‘objective’ forms. Despite persistent study, researchers fail to agree on the meaning of well-being or how it should be studied. Aim: The first half of the thesis aims to examine the meaning, measurement and theory of well-being. The second half of the thesis aims to investigate the factors associated with subjective well-being (SWB), and the influence of attributes of well-being on preferences for the future. Methods: A systematic review was conducted to identify measures of well-being for use in adults (general population). The dimensions within these measures were organised into a framework using thematic analysis. Further, the theories underpinning these measures were identified and described. Fixed-effect regression models were used to study the factors important for SWB using data from a longitudinal (1996 – 2013) cohort of middle aged-older adults in the United States (n = 2049). Finally, preferences for life in the future were estimated in a sample of young ‘emergent adults’ (n =140) in the United Kingdom, using discrete choice experiments (DCEs). Results: The systematic review identified 99 measures of well-being, which included 196 distinct dimensions. These measures were influenced by a diverse range of theories (n = 98). Mental health, social integration and satisfaction with work had a significant impact on each of the SWB outcome variables (life satisfaction, positive affect and negative affect) in the fixed-effects analysis. The DCE indicated that stated preferences for life in the future among emergent adults were particularly driven by the prospect of social support from family and an aversion to experiencing mental health difficulties. Conclusion: This thesis has investigated inconsistencies in how well-being is understood, measured and studied. In response to this, a framework has been developed which organises the many measures available around key themes. Following on from the fixed-effects analysis and the DCE, future empirical research should be undertaken to investigate the interdependence of well-being and mental health.

Reflecting the growing interest from both consumers and policymakers, and building on recent developments in Willingness to Pay (WTP) methodologies, we evaluate consumer preferences for an archetypal traditional food product. Specifically we draw on stated preference data from a discrete choice experiment, considering the traditional Hungarian mangalitza salami. A WTP space specification of the generalized multinomial logit model is employed, which accounts for not only heterogeneity in preferences but also differences in the scale of the idiosyncratic error term. Results indicate that traditional food products can command a substantial premium, albeit contingent on effective quality certification, authentic product composition and effective choice of retail outlet. Promising consumer segments and policy implications are identified. (authors' abstract)