Rozza Hebatullah H, Elhoseny Taghareed A, Abbas Safaa H, Mosallam Rasha A
High Institute of Public Health, Alexandria University, Alexandria, Egypt.
Alexandria Clinical Research Administration, Alexandria Health Affairs Directorate, Alexandria, Egypt.
J Egypt Public Health Assoc. 2025 Sep 2;100(1):15. doi: 10.1186/s42506-025-00195-x.
In economics, the word "willingness to pay" refers to the highest amount that an individual would be willing to pay, give up, or exchange to obtain goods or services or to avoid something undesirable. It can be applied in healthcare as a way to evaluate the worth of improving the quality of health services. This study aims to assess patients' willingness to pay (WTP) for healthcare quality improvement among hospitalized patients in two hospitals in Egypt.
Four-hundred and twenty-six patients were asked to provide a rating for different quality attributes. Patients were presented with a hypothetical scenario and asked about their WTP for a monthly insurance premium to benefit from improving each quality attribute. WTP was elicited using the payment card (PC) response format.
Fifty-two percent of studied patients were not willing to pay to improve healthcare quality attributes. Fifty percent of those who were willing to pay were certain to pay. The most commonly stated reasons for unwillingness to pay were "being governmental responsibility" and "household cannot afford" (43% and 36.8%, respectively). Patients were willing to pay the highest amount of money to improve the quality attributes "competence," followed by "outcome" and "doctor-patient relationship" (491.03, 465, and 423 LE, respectively). For all quality attributes, except for waiting time and availability of supplies and equipment, the amount of money the patients were willing to pay increased significantly as the perceived quality of that attribute reduced. Advancing age had a significant negative association with WTP (p = 0.002). Also, advancement in education was associated with significantly higher WTP (p < 0.001). Those with health expenditures ranging from 2000 to < 6000 LE per month were 3.38 times more willing to pay than those with health expenditures ranging from 200 to 1000 LE (p < 0.001).
WTP for quality improvement among study participants was low, being the lowest among the elderly and lower-educated individuals. Community financing should not be a method for funding quality improvements except for a few quality attributes such as doctor-patient communication and increased doctor competence. This should be coupled with clear exemption criteria for those unable to pay.
在经济学中，“支付意愿”一词指的是个人为获得商品或服务、放弃或交换物品以避免不良事物而愿意支付的最高金额。它可应用于医疗保健领域，作为评估改善卫生服务质量价值的一种方式。本研究旨在评估埃及两家医院住院患者对改善医疗质量的支付意愿（WTP）。
426名患者被要求对不同的质量属性进行评分。向患者呈现一个假设情景，并询问他们为每月保险费支付的意愿，以便从改善每个质量属性中受益。使用支付卡（PC）反应格式引出支付意愿。
52%的研究患者不愿意为改善医疗质量属性付费。愿意付费的患者中有50%确定会支付。最常提及的不愿付费的原因是“是政府的责任”和“家庭负担不起”（分别为43%和36.8%）。患者愿意支付最高金额以改善“能力”这一质量属性，其次是“结果”和“医患关系”（分别为491.03埃及镑、465埃及镑和423埃及镑）。对于所有质量属性，除了等待时间以及物资和设备的可用性外，随着患者对该属性感知质量的降低，他们愿意支付的金额显著增加。年龄增长与支付意愿呈显著负相关（p = 0.002）。此外，教育程度的提高与显著更高的支付意愿相关（p < 0.001）。每月医疗支出在2000至<6000埃及镑之间的患者比医疗支出在200至1000埃及镑之间的患者愿意支付的可能性高3.38倍（p < 0.001）。
研究参与者对质量改善的支付意愿较低，在老年人和受教育程度较低的个体中最低。除了少数质量属性，如医患沟通和医生能力提高外，社区融资不应作为为质量改善提供资金的方法。这应与针对无力支付者的明确豁免标准相结合。
