The Willingness-to-Pay for General Practitioners in Contractual Service and Influencing Factors among Empty Nesters in Chongqing, China.
BACKGROUND
In 2012, a pilot health policy of contractual service relations between general practitioners and patients was implemented in China. Due to the decline in body and cognitive function, as well as the lack of family care and narrow social support networks, the demand of health services among the elderly is much higher than that among the general population. This study aims to probe into the empty nesters' willingness-to-pay for general practitioners using a contractual service policy, investigating empty nesters' payment levels for the service, and analyze the main factors affecting the willingness of empty-nesters' general practitioners using contractual service supply cost.


METHODS
This cross-sectional study adopted a multistage stratified sampling method to survey 865, city empty nesters (six communities in three districts of one city) aged 60-85 years. A condition value method was used to infer the distribution of the willingness-to-pay; Cox's proportional hazards regression model was used to analyze the influencing factors of willingness-to-pay.


RESULTS
More than seventy percent (76.6%) of the empty nesters in this city were willing to pay general practitioners using contract service in Chongqing. The level of willingness-to-pay for the surveyed empty nesters was 34.1 yuan per year. The median value was 22.1 yuan per year, which was below the Chongqing urban and rural cooperative medical insurance individual funding level (60 yuan per year) in 2013. Cox's proportional hazards regression model analysis showed that the higher the education level was, the worse the self-reported health status would be, accompanied by higher family per capita income, higher satisfaction of community health service, and higher willingness-to-pay empty nesters using a contract service. Women had a higher willingness-to-pay than men.


CONCLUSIONS
The willingness-to-pay for general practitioners by contractual service is high among city empty nesters in Chongqing, thus, individual financing is feasible. However, people are willing to pay less than half of the current personal financing of cooperative medical insurance of urban and rural residents. Education level, family per capita income, and self-reported health status are the main factors affecting the cost sharing intention for general practitioners using contract service supply. According to the existing situation of different empty nesters, it is important to perfect the design of general practitioners using a contractual service policy system, according to differentiated personal financing levels.
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China. chenfei6639@126.com.|School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China. chenfei6639@126.com.
Fei
F
Chen
School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China. xianglong1989@126.com.
Xiang-Long
XL
Xu
College of Foreign Languages, Chongqing Medical University, Chongqing 400016, China. zenith_fat@126.com.
Zhan
Z
Yang
School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China. tanhuawei-2009@163.com.
Hua-Wei
HW
Tan
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China. zhangliang@mails.tjmu.edu.cn.
Liang
L
Zhang
D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000191:economics* / Q000458:organization & administration; D019538:Health Care Surveys; D006291:Health Policy / Q000191:economics; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D016016:Proportional Hazards Models
Contingent Valuation Method; Cox’s proportional hazards regression model; contractual service; empty nesters; general practitioners; willingness-to-pay