Willingness to pay for improved long-term care insurance among beneficiaries or primary family caregivers in a Chinese pilot city: A contingent valuation study

Background Chinas rapidly ageing population has increased the demand for long-term care insurance (LTCI), while the sustainability of current financing arrangements remains uncertain. Understanding willingness to pay (WTP) for improved LTCI services among LTCI beneficiaries or primary family caregivers may provide empirical evidence for discussions on acceptable and sustainable contribution mechanisms. Methods We conducted a contingent valuation survey among 278 LTCI beneficiaries or primary family caregivers in Panjin City, Liaoning Province, China. An iterative bidding game with randomized starting bids was used to elicit monthly WTP for a predefined LTCI service improvement scenario. Tobit regression models with heteroskedasticity-robust standard errors were used to estimate factors associated with WTP, including household income, disability severity, satisfaction with current services, and demographic characteristics. Results The mean monthly WTP for improved LTCI services was approximately CNY 300, compared with the current average monthly premium of approximately CNY 120. The median WTP was CNY 250. Higher household income was positively associated with WTP. Compared with participants with monthly household income below CNY 5,000, those in the highest income group above CNY 30,000 reported an additional WTP of CNY 178.9. More severe disability was also associated with higher WTP, whereas greater satisfaction with current LTCI services was associated with lower WTP. These associations were generally consistent across alternative model specifications. Conclusions LTCI beneficiaries or primary family caregivers in this Chinese pilot city reported a willingness to contribute more for improved LTCI services, particularly among those with higher income, greater care needs, or lower satisfaction with current services. These findings may inform discussions on differentiated contribution arrangements and service quality improvements in LTCI financing reform. However, the results should be interpreted cautiously because the study was conducted in a single pilot city and relied on stated-preference data.