Study On Willingness To Pay For Home Health Care Services Of The Elderly In Shanghai

Objective: Shanghai has the highest percentage of aging population in China. With theaccelerated speed of aging population, the contradiction between the supply andrequirement of health resources is becoming aculeate. To carry out home health careservices has been adopted as a key strategy to alleviate the aging social contradictions.However, the system of home health care services in Shanghai is in a low level. Thus assoon as possible to understand the needs of the elderly, to investigate the willingness to payfor home health care services and to analyse those factors affecting WTP, you caneffectively assess the needs of the elderly, provide policy decision-makers with the pricingreference and lay the foundation for further exploration of its paid compensationmechanism.Methods: According to the principle of WTP survey, we firstly revised home health careservices of the elderly in Shanghai by literature research, semi-structured interviews andthe results of preliminary research groups. Secondly, through expert consultation and pilotsurvey to determine the price of the services, the final questionnaire of willingness to payfor home health care services of the elderly was designed. Finally, face-to-face interviewswere conducted by stratified sampling and convenience sampling with the self-designedquestionnaires in the respondents’ own homes between November2012to January2013,as to know the willingness to pay for home health care services of the elderly and analyzethose factors affecting WTP.550native elderly enrolled in the interviews as a result.General information was used descriptive statistical analysis and we tested the relationshipbetween general information and the total willingness to pay by chi-square test and therelationship between general information and the bids of willingness to pay for differentservices by non-parametric test (U-test, or H test). And significant variables in theunivariate analysis were further made logistic regression or multiple regression analysis. Results：1. WTP for home health care servicesMore than half of the elderly (60.5%) were willing to pay for home health careservices.35.6%of the respondents were willing to pay monthly maximum200to300yuan.Respondents’ lowest acceptable average reimbursement ratio for home health care serviceswas67.24%±23.55%. Four categories of22items were suitable for home health careservices of the elderly in Shanghai. The average bids of WTP for categories of EducationalInstruction Services, Auxiliary Monitoring Services, the General Treatment Care and theSpecial Curative Care were separately$3.00to8.00yuan/times,$4.00to8.00yuan/times,$6.00to10.00yuan/times and$10.00to20.00yuan/times.2. The demand for home health care servicesThe willingness to pay for22items (WTP≠0), can approximately reflect the status ofthe elderly on the demand for services. The rates of WTP were ranging from76.36%(dietary guidance) to94.91%(intravenous infusion), the top five were: intravenousinfusion (94.91%), the injectable (94.73%), bladder irrigation (94.18%), blood sugarmeasuring (93.64%) and blood samples collecting (93.45%). In contrast, the EducationalInstruction Services were in the low demand rate.3. Influencing factorsFactors affecting WTP for home health care services of the elderly were economicconditions, whether established a family bed, whether convenient to see a doctor, with orwithout his own or spouse work, self-feeling psychological distress and whether sufferedfrom diabetes. The one who was in better economic conditions, established a family bed,the more inconvenient to see a doctor, with his own or spouse work, the lower levels ofself-feeling psychological distress and suffered from diabetes had the stronger willingnessto pay for home health care services and the bids of WTP were more bigger.Conclusion: The degree of willingness to pay for different items was different, but overallthe elderly hold a positive attitude for home health care services,which meant home healthcare services of the elderly having a broad market prospect. Health service providers should vigorously carry out door-to-door services to really benefit the elderly bybroadening service projects and improving the quality of services. Based on the nationalconditions of "old before getting rich", the payment tems of home health care servicesshould be shared together by goverment and individuals.The results of our survey canmake reference for the paid compensation mechanism of home health care services. Itimplied that, as well as providing paid or low compensation home health care services forthe other elderly,the government should appropriately increase the amount ofcompensation for those who were in worse economic conditions (<2,000yuan/month). Itsuggested that home health care services could be carried out in those who were in bettereconomic conditions (>4000yuan/month), had a family bed, less convenient to see adoctor and suffered from diabetes, and then the scope enlarged to include the other elderly,in order to meet the needs of the elderly at different levels, to ensure the sustaineddevelopment of home health care services and to promote the sustainable development ofhome health care services.