Abstract
BackgroundThe Japanese healthcare system has undergone reforms to address the struggles that municipality hospitals face. Reform guidelines clearly define criteria for administrative improvement. However, criteria to evaluate the demand for healthcare provisions in rural Japan, including the needs of rural residents for municipality hospitals in particular have not been specified. The purpose of this paper is to measure residents' willingness to pay (WTP) for municipality hospital services using the contingent valuation method, and to evaluate municipality hospital valuation on the basis of WTP. K town, located in the Hokkaido prefecture of Japan, was selected as the location for this study. Participants were recruited by a town hall healthcare administrator, hospital and clinic staff, and a local dentist. Participants were asked what amount they would be willing to pay as taxes to continue accessing the services of the municipality hospital for one year by using open-ended questions in face-to-face interviews.FindingsForty-eight residents were initially recruited, and 40 participants were selected for the study (response rate 83%). As compared to K town's population, this data slanted toward the elderly, although there was no significant difference in frequency among the characteristics. The median WTP was estimated at 39,484 yen ($438.71), with a 95% confidence interval 27,806-55,437 yen ($308.95-615.96). Logistic regression revealed no significant factors affecting WTP.ConclusionsIf the total amount of residents' WTP for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844). This is approximately equal to the amount of money to be transferred from the general account of the government of K town, more than one-half of the town tax of K town, and about two-fold in comparison to Japan as a whole. This showed that K town's residents placed a high valuation on the municipality hospital, which nearly equalled the amount that the K town government provided to the municipality hospital to cover its annual deficit. K town residents had come to expect not only general clinical practice, but also emergency medical services and night practice provided by their own town's municipality hospital. WTP can be used as a measure of hospital evaluation because it reflects the importance of the hospital to the residents in its region.
Highlights
The Japanese healthcare system is very efficient and offers high quality care
If the total amount of residents’ willingness to pay (WTP) for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844)
This showed that K town’s residents placed a high valuation on the municipality hospital, which nearly equalled the amount that the K town government provided to the municipality hospital to cover its annual deficit
Summary
The Japanese healthcare system is very efficient and offers high quality care. According to the Organization for Economic Cooperation and Development (OECD) Health Data, in 2007, Japanese medical costs per Gross Domestic Product (GDP) were 8.1%, half that of the United States (16.0% of GDP). If the hospital offered emergency care or night services or if the residents used its services often, it would have a high valuation Those valuations, such as expectancy and complacency derived from hospital existing in local area for residents, are the non-market value. The contingent valuation (CV) method is used to evaluate this non-market value, and can evaluate by using comparable measurements such as monetary value [7] In this approach, the investigators provided participants with a fact sheet and a hypothetical situation with research questions. Ringburg et al in their evaluation of the WTP for helicopter emergency medical services in the Netherlands evaluated the WTP not by a CV method but by a discrete choice experiment [13] This method is able to ask the value of multiple programs for the same group of participants. This method could not be applied to our study because we targeted only the municipality hospital
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