VALUING HIDDEN INPUTS TO HOSPITAL CARE: WILLINGNESS TO PAY AND WILLINGNESS TO ACCEPT COMPENSATION FOR INFORMAL INPATIENT CAREGIVING IN CHINA
Author(s)
Huixuan Gao, PhD1, Tingqiu Wu, MA2, Wei Chen, MSc3, Enpeng Xing, BScN4, Yuxia Jiang, BMed5, Jing Zhou, MMed5.
1Department of Health Policy, London School of Economics and Political Science, London, United Kingdom, 2Independent Researcher, Shanghai, China, 3London School of Economics and Political Science, London, United Kingdom, 4Department of Vascular Surgery, Binzhou People's Hospital, Binzhou, China, 5Department of Oncology, Affiliated Hospital of Shandong Medical And Pharmaceutical University, Binzhou, China.
1Department of Health Policy, London School of Economics and Political Science, London, United Kingdom, 2Independent Researcher, Shanghai, China, 3London School of Economics and Political Science, London, United Kingdom, 4Department of Vascular Surgery, Binzhou People's Hospital, Binzhou, China, 5Department of Oncology, Affiliated Hospital of Shandong Medical And Pharmaceutical University, Binzhou, China.
OBJECTIVES: Unpaid family caregivers provide inpatient bedside care in China, as in many health systems, yet this input is rarely valued economically. Unlike home care, inpatient caregiving centres on patient-directed tasks, with less household-production overlap. As China pilots "no-companion" wards, shifting some bedside care to paid assistants, valuation is policy-relevant. We valued one-hour daily change using willingness to pay (WTP) for replacement care and willingness to accept (WTA) for additional care, examining caregiver only-child status (one-child policy) and daily-living versus treatment task breadth.
METHODS: A cross-sectional contingent-valuation survey included 365 informal caregivers across multiple Chinese hospitals. Payment cards followed by exact-amount questions elicited WTP and WTA. Logistic models estimated willingness to pay and provide additional care; gamma-GLMs with log links estimated positive amounts. Models adjusted for caregiver, care-recipient and caregiving characteristics, hospital fixed effects and robust standard errors.
RESULTS: Overall, 62.5% reported positive WTP, and 54.8% were willing to provide the additional daily hour; among the latter, 18.0% required no compensation. Median positive WTP was CNY 45/day (€5.8; IQR 21-80) and median WTA, among those requiring compensation, CNY 50/day (€6.5; IQR 30-100). In adjusted willingness models (n=289), only-child status was associated with a 17.6-percentage-point lower probability of providing additional care (95% CI, −30.2 to −5.1), but not with willingness to pay. Each additional daily-living task was associated with a 5.5-percentage-point higher probability (95% CI, 2.2-8.8). Among positive payers (n=181), each additional treatment-related task was associated with lower mean WTP (mean ratio, 0.93; 95% CI, 0.87-0.99).
CONCLUSIONS: Applying contingent valuation to hospital-based informal caregiving highlights two distinct valuation margins: demand for replacement care and willingness to extend family care. Their differing associations with only-child status and task breadth suggest that a single average hourly value may mask heterogeneity. Economic evaluations should distinguish these margins when assessing policies that replace, supplement, or reorganise family inpatient care.
METHODS: A cross-sectional contingent-valuation survey included 365 informal caregivers across multiple Chinese hospitals. Payment cards followed by exact-amount questions elicited WTP and WTA. Logistic models estimated willingness to pay and provide additional care; gamma-GLMs with log links estimated positive amounts. Models adjusted for caregiver, care-recipient and caregiving characteristics, hospital fixed effects and robust standard errors.
RESULTS: Overall, 62.5% reported positive WTP, and 54.8% were willing to provide the additional daily hour; among the latter, 18.0% required no compensation. Median positive WTP was CNY 45/day (€5.8; IQR 21-80) and median WTA, among those requiring compensation, CNY 50/day (€6.5; IQR 30-100). In adjusted willingness models (n=289), only-child status was associated with a 17.6-percentage-point lower probability of providing additional care (95% CI, −30.2 to −5.1), but not with willingness to pay. Each additional daily-living task was associated with a 5.5-percentage-point higher probability (95% CI, 2.2-8.8). Among positive payers (n=181), each additional treatment-related task was associated with lower mean WTP (mean ratio, 0.93; 95% CI, 0.87-0.99).
CONCLUSIONS: Applying contingent valuation to hospital-based informal caregiving highlights two distinct valuation margins: demand for replacement care and willingness to extend family care. Their differing associations with only-child status and task breadth suggest that a single average hourly value may mask heterogeneity. Economic evaluations should distinguish these margins when assessing policies that replace, supplement, or reorganise family inpatient care.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE760
Topic
Economic Evaluation, Health Policy & Regulatory, Patient-Centered Research
Topic Subcategory
Novel & Social Elements of Value, Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas