| BackgroundUpper gastrointestinal cancer(UGC)is a high incidence of malignant tumor in China,which has brought a huge burden of disease to residents in high incidence areas.Early screening can significantly reduce the morbidity and mortality of UGC,which is an effective,economical and feasible cancer prevention and control measure.However,the sustainable development of screening cannot be separated from the problem of who pays and the amount of payment.At present,most people have to pay all their own expenses to obtain screening services,which largely affects the participation rate and sustainability of screening.Therefore,to clarify the acceptance and the cost-sharing mechanism of cancer screening,and to improve the participation rate of endoscopic screening among high-risk groups of UGC has become an important topic that needs to be urgently studied.ObjectiveTo investigate the willingness to choose and pay for endoscopic screening among UGC high-risk groups in Shandong,and analyze its influencing factors,so as to provide reference information for improving the participation rate and promoting the sustainable development of UGC screening.Data and MethodsThis study selected Linqu and Feicheng as the survey sites in UGC high incidence area in Shandong.Using cluster random sampling method,2-5 villages were randomly selected from each county,and 653 valid questionnaires were collected from the high-risk population of rural villages aged 40-69 who had not been diagnosed with cancer in the past.Based on Contingent Valuation Method(CVM),a face-to-face survey of the respondents’willingness to choose and pay for endoscopic screening was conducted by using the combination of double-bounded dichotomous choices and open-ended questions,and the endoscopic screening was divided into two scenarios:general endoscopic screening(GES)and painless endoscopic screening(PES).Chi-square test and non-parametric test were used for univariate analysis.The factors affecting the willingness to choose and pay for endoscopic screening were analyzed by using multivariate logistic regression model and Tobit model,respectively.All data were analyzed using STATA 16.0 software.ResultsAmong 653 high-risk groups,there were more female than male,the average age was 57.00±7.03 years,and the respondents were mainly degree of junior high school,married,farmers,with an annual income of 10000-30000 yuan,and participating in urban and rural residents’ medical insurance.Most of the respondents were in good health,blood relatives did not suffer from cancer,and had no previous upper gastrointestinal symptoms,accounting for 64.62%,77.79%and 66.31%of the total population,respectively.More than half of the residents have participated in endoscopic screening,accounting for 66.16%.In the total population,56.05%were willing to choose GES;43.95%were not mainly because they were "worried about pain or danger in the examination".Logistic regression showed that the proportion of residents in Linqu County who were unwilling to choose GES was 5.352 times that of Feicheng residents,the proportion of female who were unwilling to choose GES was 2.290 times that of male,the proportion of people who have no endoscopic screening experience was unwilling to choose GES was 1.997 times that of people with endoscopic screening.The average willingness to pay for GES was 214.62±194.55 yuan,with a median of 200 yuan.Linqu residents were less willing to pay 56.94 yuan/person than Feicheng.People aged 50-59 and 60-69 were willing to pay 65.15 yuan/person and 78.96 yuan/person less than those aged 40-49,respectively.The higher the annual family income,the higher willingness to pay of high-risk groups for GES.For every 1000 yuan increase in annual income,the amount of willingness to pay of high-risk groups will increase by 1.28 yuan/person.Among 653 high-risk groups,89.28%of the high-risk population were willing to choose painless endoscopic screening,and 10.72%were not mainly because they will "see a doctor after feeling unwell".The logistic regression results were as follows.The proportion of residents in Linqu County who were unwilling to choose PES was 7.488 times that of residents in Feicheng City,the proportion of residents who have never had upper gastrointestinal symptoms before was unwilling to choose painless endoscopic screening was 3.532 times that of residents who had symptoms before,and the proportion of residents who have not participated in endoscopic screening was 3.1 75 times that of residents who have participated in endoscopic screening.The average willingness to pay for PES among high-risk groups was 299.97±330.10 yuan,with a median of 200 yuan.Tobit regression results were as follows.Linqu residents were less willing to pay 123.65 yuan/person than Feicheng.Residents aged 60-69 were willing to pay 108.06 yuan/person less than residents aged 40-49.The self-employed,farmers and other occupational groups were willing to pay 164.67 yuan/person,118.86 yuan/person and 276.02 yuan/person more than civil servants,public institutions,enterprise personnel or workers,respectively.The higher annual family income,the higher willingness to pay of PES high-risk group.The amount of willingness to pay of the high-risk group will increase by 1.60 yuan/person for every 1000 yuan increase in annual income.Conclusions and SuggestionsConclusions:Compared with GES,the high-risk population of UGC in Shandong had a higher willingness to choose PES.Nearly half of the people were not willing to choose general endoscopic screening,mainly due to concerns about the pain or danger of the examination;A small number of people were reluctant to choose painless endoscopic screening,mainly because they will seek medical advice on their own after feeling unwell.Region,history of upper gastrointestinal symptoms,and history of endoscopic screening were significant influencing factors that affected the population’s willingness to choose screening.Whether it was GES or PES,high-risk groups were less willing to pay and were willing to pay relatively low.Region,age and income were significant influencing factors that affected the willingness of the population to pay for screening.Suggestions:(1)Focus on the health needs of high-risk groups to improve the participation rate of endoscopic screening.(2)Strengthen the standardized training of endoscopy,improve the operation technology and the comfort of the examination environment.(3)Strengthen the health education activities of pre-cancer screening to improve the awareness of cancer screening.(4)Establish a reasonable screening cost-sharing mechanism to promote the sustainable development of screening.It was suggested that the appropriate proportion of self-payment for endoscopic screening should be controlled between 30%and 40%. |
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