A Study of Patients' Willingness to Pay for a Basic Outpatient Copayment and Medical Service Quality in Taiwan.

Wei Hsu,Wen-Ping Fan,Chih-Hao Yang

doi:10.3390/ijerph18126604

Abstract

Patients might be willing to pay more to obtain better quality medical services when they recognize that high-level hospitals have better quality. However, published papers have not found solid empirical evidence to support this possibility. Therefore, the purpose of this study is to empirically investigate patients’ willingness to pay (WTP) for an outpatient copayment. The study aims to analyze the difference between the two WTP values: to implement a hierarchy of medical care and to improve the quality of medical services. This study administered a questionnaire using the contingent valuation method with a quasi-bidding game for patients’ WTP and the SERVQUAL scale for medical service quality. The Wilcoxon signed-rank test was employed to test the difference between the two WTP values, notably to implement a hierarchy of medical care and to improve the quality of medical services. Both of the WTP values are higher than the academic medical centre’s current copayment NT$420 (approximately US$14); the percentage of respondents willing to pay a higher copayment declined when the outpatient copayment was increased, and the patients’ WTP to have better medical service quality was significantly higher than that to implement a hierarchy of medical care. Patients’ desire to receive better medical services from higher-level hospitals might be stronger than their desire to implement hierarchical medical care. This study reported the relationship between the respondents’ perceived medical service quality and WTP for having better service quality by using regression models. The respondents’ perceptions of medical service quality, especially for “reliability” and “assurance,” would positively affect their WTP. Policy makers should focus on improving the quality of medical services.

Highlights

In order to avoid that the respondents might feel confused by the different amounts of outpatient copayments in the different levels of hospitals, the research object of this study focused on patients of academic medical centers and did not investigate other levels of the hospital hierarchy since the National Health Insurance (NHI) of Taiwan has already adjusted the amount of outpatient copayments without referral for medical centers three times from 1995 until now
The purpose of this study is to investigate the willingness of Taiwanese people to pay an outpatient copayment to implement hierarchical medical care and to have better medical service quality, as well as the difference between the willingness to pay (WTP) to implement hierarchical medical care and to have better medical service quality
The results showed that the majority of the respondents believed that the academic medical center provided good service; that is, the service provided by the staff of the academic medical center was as promised and that the staff members were polite, knowledgeable and trustworthy

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Since the National Health Insurance (NHI) system of Taiwan was created in 1995, the NHI of Taiwan provides medical services with acceptable quality levels; the utilization rate of medical services has grown rapidly. The Ministry of Health and Welfare of Taiwan adopted a copayment system for outpatient care to eliminate the waste of medical resources. To implement a hierarchy of medical care, copayments vary across different levels of medical institutions. The hierarchy of medical care in Taiwan includes four levels. The outpatient copayment without referral rose from

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Conclusion