Older Adults Preferences for Long-Term Caregivers in China: A Discrete Choice Experiment

OBJECTIVES: Understanding the preferences of old-age adults for their long-term caregivers can improve the implementation of person-centered health care, optimize long-term care (LTC) services and enhance the quality of LTC. There is little evidence about Chinese older adults' preferences for long-term caregivers. We aimed to examine Chinese older adults' preferences for long-term caregivers.

METHODS: A national representative discrete choice experiment (DCE) was conducted to collect data from 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments and quality of life (QoL). Preferences were derived using mixed logit and latent class model. The marginal willingness to pay (WTP) was estimated.

RESULTS: Among 2031 older adults aged between 50 and 70 years old, older adults displayed higher preferences for long-term caregivers who would improve their QoL, incur less out-of-pocket payments and provide medical LTC services, with the maximum WTP of $22.832 per month. QoL was rated as the most important, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95%CI, 16.858 to 20.137) and the uptake rate increased by 76.47%. Compared to receiving care at home, older adults did not prefer community, nursing institutions or medical institutions care. There was preference heterogeneity among older people with different gender, education, family size and knowledge of LTC insurance.

CONCLUSIONS: Older Chinese adults valued caregivers who improvement their QoL most. Home care and medical care from formal caregivers was preferred by older adults. We recommend implementing the training of family caregivers; improving the quality of home-based care by professional caregivers; raising older people’s awareness of long-term care insurance; and guide policymakers in developing people oriented LTC and multi-level LTC system.