OBJECTIVE: Despite increased use in the healthcare sector (HCS), the contingent valuation (CV) method remains controversial. The nucleus of the controversy is the extent to which hypothetical choices in the CV method mimic real economic choices. Correspondence between hypothetical and real willingness to pay (WTP) has been studied for private and environmental goods. These experiments demonstrate that dichotomous choice (DC) CV questions lead to hypothetical bias (overestimation of real WTP). Hypothetical bias has not been assessed in the HCS. We conducted an experiment directly comparing responses to a DC CV question with real purchase decisions using a pharmacist provided asthma management service as the item being valued. We examined whether DC CV questions lead to hypothetical bias for this good, and we tested whether “definitely sure” hypothetical yes responses, as identified in a follow-up question, correspond to real yes responses. METHODS: 172 subjects with asthma were recruited from 10 Kentucky community pharmacies. Subjects received either a DC CV question or were given the opportunity to actually purchase the service. Three different prices were used: $15, $40, and $80. RESULTS: In the hypothetical group 38% of subjects stated they would purchase the good at the given price, but only 12% of subjects in the real group purchased the good (p=0.000). We cannot, however, reject the null hypothesis that “definitely sure” hypothetical yes responses correspond to real yes responses. CONCLUSIONS: The DC CV method overestimates WTP in the HCS, but it may be possible to correct for this by sorting out “definitely sure” yes responses.