Study On Willingness To Pay Of Minors In The Urban Residents, Basic Medical Insurance Of Tangshan City In Hebei Province

Objective: This study adopted Contingent Valuation Method, Conjoint analysis willingnessto financing ratio to estimate respectively the willingness to pay(WTP)of minorsparticipating the Urban Residents’ Basic Medical Insurance of Tangshan City and thepreference for the attributes of medical insurance plans. At the same time, the studypredicted residents’ acceptance rate of different household premium, residents’ preferenceof different medical insurance plans and obtained the appropriate proportion of householdpremium to government financial subsidies. It compared and confirmed results predictedfrom three methods, and evaluated rationality of financing criteria of the current policies.The study also figured out the significant influencing factors of WTP and its differencesamong different populations to provide references for further dividing financing criteria.The study will further improve the theory and methods of measuring WTP, andexplore the applicability of WTP in medical insurance field in our country so as to providescientific references for formulating financing criteria.Methods: Based on the theories and methods of health economics and health statistics, thestudy conducted face-to-face household survey and adopted various WTP estimatingmethods to investigate the WTP of minors participating in the Urban Residents’ BasicMedical Insurance.(1)Following data collection methods were used:①Literature review;②Delphi method;③Field survey.(2)Material analysis:①Contingent valuation method:Investigated the WTP with the bidding game guide technology on the premise of ahypothetical medical insurance treatment.②Conjoint analysis: After determining theattributes and levels of different medical insurance plans, orthogonal design was applied toreduce the potential scenarios to a manageable number. The surveyed households wereasked to score from0to100representing their preferences for different combinations.③Willingness to financing ratio: from the perspective of family, the survey obtained the appropriate proportion of family premium to government financial subsidies.④Healthstatistical methods: Statistical description, chi-square test, t-test, non-parametric tests,ordinal multivariate logistic regression, conjoint analysis and other statistical inferencemethods were used to analyze the level and distribution of WTP and its influencing factors.Results: The study eventually drew the following conclusion by adopting three differentmethods estimating the WTP.(1)Contingent Valuation Method indicated that:①Themedium of WTP is100yuan while nearly75%of the households’ WTP reach to76yuan.About half of the households were willing to pay114yuan for most as well as up to aquarter of households are willing to pay152yuan for most.②The probability model ofhouseholds acceptances for different premium levels was given asP=Probit-1(2.031-0.018X)(X represents household premium, P represents residents’acceptance rate of different household premium).(2)Conjoint Analysis indicated: Therelative mean importance values for each attributes in descending order are: whether thegeneral outpatient cost is reimbursed, the level of household premium, reimbursement ratiofor Tertiary Hospitals, deductible for Tertiary Hospitals, top line of reimbursement. In somecases, there were likely to compromises in aspects of the level of household premium andthe top line of reimbursement.(3)Willingness to financing criteria ratio:①As financingcriteria were distinctively set to100yuan and200yuan, the median of the proportion ofhousehold premium to government financial subsidies were0.67and0.54.②Doubledfinancing criteria would lead to a reduction of about25%in the proportion.③Eachincrease of1yuan in government subsidy would in all probability lift the householdpremium by3/7yuan.(4)The results of three methods comparison:①There was evidencethat the household premium could increase to100yuan.②The Results indicated that grossannual income of the family, whether located in village-in-city or not, minors’ age could bethe significant factors affecting WTP. The WTP of0-5years old group was14.6yuanhigher than the6-17years old group with a95%confidence interval being6.2to23.2;while the WTP of village-in-city group was28.7yuan lower than the non-village-in-citywith a95%confidence interval being18.4to38.9. There was significant difference of WTPbetween extreme income (less than$10,000and$100,000or more) groups. The studydidn’t find evidence to demonstrate the middle income levels and WTP were positively correlated.③Three calculated results showed good consistency and perceptiveness whichcould provide reasonable reference for government to adjust financing criteria.Concl`usions:(1) WTP differs greatly in different populations. For example, the WTP of0-5years old group was14.6yuan higher than the6-17years old group, while the WTP ofvillage-in-city group was28.7yuan lower than the non-village-in-city group; the familywith better conomic condition tends to pay higher premium.(2)The preference for medicalinsurance plans diversifies in different populations. Village-in-city group pay most attentionto household premium,While non-village-in-city group pay most attention to whether thegeneral outpatient cost is reimbursed; less than$10,000group pay more attention to topline of reimbursement than deductible,while more than$10,000group held opposite views;more than$80,000group pay more attention to reimbursement ratio, while less than$80,000group pay more attention to whether the general outpatient cost is reimbursed;Gender and age on residents’ preferences had no significant differences, they all pay mostattention to whether the general outpatient cost is reimbursed, followed by family pay cost.(3) Whether the general outpatient cost is reimbursed had great influence on WTP.Residentsmostly valued whether the general outpatient cost of multiple and common diseases isreimbursed among the relative values for each attributes.(4) WTP measuring methods has awide range of applicability.WTP measuring methods are not only applicable to minors, butcan be expanded to other insured groups, such as non-employed residents in labor age, oldpeople within the scope of policies, and so on. WTP measuring methods has a wide rangeof applicability in field of medical insurance.Suggestions: To further enhance the satisfaction degree of the Urban Residents’ BasicMedical Insurance and the rationality of household premium level, the study has proposedthe following recommendations:(1) To improve the household premium. The householdpremium can be lifted to100yuan. It is a promising and feasible plan to set the householdpremium to100yuan, the deductible to900yuan, reimbursement ratio to60%and top lineof reimbursement to200,000and bring general outpatient cost into reimbursement.(2)Todevelop financing criteria for different segments of the residents. The government couldfund according to different population groups including0-5years old group and6-17yearsold group that are suggested to set the standard deviation of household premium funding as 10-15yuan, and minors in village-in-city and minors not in village-in-city which aresuggested to set the standard deviation as20-30yuan.(3)Scientific calculation methodsshould be the basis for adjustments of financing criteria. To improve the fairness of fundingand the attractiveness of policies, the government should make and adjust its fundingstandard based on scientific calculation methods, take economic development situation,medical needs of different populations, and the burden of family and the government intoconsideration.