Willingness To Pay For Potential Enhancements To A Low-Cost Cataract Surgical Package In Rural Southern China

1. Nathan Congdon⁴
2. Fang Ko¹
3. Kevin D Frick²
4. Jonathan Tzu³
5. Mingguang He⁴

¹Wilmer Eye Institute, Baltimore, Maryland, USA
²Department of Health Policy and Management, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
³Bascom Palmer Eye Institute, Miami, Florida, USA
⁴State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China

Purpose: To assess determinants of patients' willingness to pay (WTP) for possible components of a multi-tier cataract surgical pricing plan at a rural Chinese hospital supported by a non-governmental organization, as part of improving sustainability of the program through cost recovery.

Methods: Demographic and clinical data were collected on 505 patients presenting for cataract screening or surgery in Yangjiang, China. WTP 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, 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, mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36, and imported IOL US$89.4 ± 4.19. The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to current program price of US$65). In multivariate models, WTP for senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42 – 3.18, P < 0.001). WTP for 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 program revenues through multi-tiered offerings in this setting. Personal familiarity with cataract surgery is important in determining WTP.