Improving equitable access to cataract surgery in rural southern China: Using willingness to pay data to assess the feasibility of a tiered pricing model to subsidize surgeries to the poorest

Aim. To assess the equity of financial access to cataract surgery given willingness to pay (WTP) for cataract surgery at the current price of surgery and for added amenities such as surgery by a senior surgeon, an improved intraocular lens, transport and food. To determine the feasibility of a tiered pricing and cross-subsidization model using these estimates.; Methods. A WTP survey was administered at community screenings and hospital cataract surgery clinics in rural Guangzhou. WTP was estimated using interval regression and then compared to the price of surgery to determine access. A further equity analysis was conducted using concentration indices and curves. The WTP for amenities was similarly analyzed to determine potential demand.; Results. WTP surveys were conducted with 656 patients and 342 of their caregivers. The mean WTP for the community screening patients was 371 RMB (S.D. 114RMB) and 570RMB (S.D. 69RMB) for the hospital patients (8RMB =US{dollar}1). For caregivers the mean was 619 RMB (S.D. 77 RMB). At the two prices charged by HKI, 500RMB and 630RMB, the estimated concentration indices were 0.18 and 0.36 for patients, which implies that financial access is inequitably concentrated amongst the wealthier patients. However, the respective index measures were 0.01 and 0.10, for caregivers indicating lower inequity at 630RMB and no inequity at 500RMB. The WTP for amenities was low, only 78RMB for a senior surgeon and 42RMB for an improved IOL.; Conclusion. Access to cataract surgery is inequitably distributed between the poor and the poorest in this population even at cost, 500RMB. We determined that not enough patients would be able to purchase surgery at higher, tiered prices for additional amenities in order to subsidize any significant number of surgeries at a lower price. While WTP for cataract surgery was significantly higher when assessed by patient's caregivers, adjusting for this did not change the finding that access is inequitable for this population and creative ways must be found to lower prices.