title: Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China.
abstract: OBJECTIVE
  To assess determinants of patients' willingness to pay (WTP) for potential components of a multi-tiered cataract surgical package offered by a non-governmental organization (NGO) in rural China.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Demographic and clinical data were collected from 505 patients presenting for cataract screening or surgery in Yangjiang, China. Willingness to pay for potential enhancements to the current surgery package was assessed using a bidding format with random payment cards.
  
  
  RESULTS
  Among 426 subjects (84.4%) completing interviews, the mean age was 73.9 ± 7.3 years, 67.6% were women and 73% (n = 310) would pay for at least one offering, with 33-38% WTP for each item. Among those who would pay, the mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36 and US$89.4 ± 4.19 for an imported intra-ocular lens (IOL). The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to the current programme price of US$65). In multivariate models, WTP for the senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42-3.18, p < 0.001). Willingness to pay for the imported IOL increased with knowledge of a previously operated person (OR = 1.85, 95% CI 1.24-2.75, p < 0.01) and decreased with age >75 years (OR = 0.61, 0.40-0.93, p < 0.05).
  
  
  CONCLUSIONS
  Opportunities exist to increase cataract programme revenues through multi-tiered offerings in this setting, allowing greater subsidization of low-income patients. Personal familiarity with cataract surgery is important in determining WTP.
authors.affiliation: Wilmer Eye Institute, Baltimore, Maryland, USA.
authors.forename: Fang
authors.initials: F
authors.lastname: Ko
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tzu
authors.forename: Mingguang
authors.initials: M
authors.lastname: He
authors.forename: Nathan
authors.initials: N
authors.lastname: Congdon
mesh_terms: D000368:Aged; D002387:Cataract Extraction / Q000191:economics*; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005249:Fees and Charges; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000191:economics; D007910:Lenses, Intraocular / Q000191:economics*; D008297:Male; D019035:Rural Health Services / Q000191:economics*; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014792:Visual Acuity / Q000502:physiology