Preferences and Heterogeneity in Care Service Needs among Disabled Older Adult in an Urban Setting

Xuewei Zhao^1*jun zhao^2*

• ¹Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
• ²The First Affiliated Hospital With Nanjing Medical University, Nanjing, China

【Abstract 】Background: Against the backdrop of an accelerating aging population, notable disparities exist in the demand for care services among the older adult. Objective: This study aims to elucidate the heterogeneous preferences and willingness-to-pay for care services among self-caring older adult and those with varying levels of functional disability, in order to provide evidence-based insights for optimizing resource allocation. Methods: A discrete choice experiment (DCE) was designed, incorporating five core attributes: service content, delivery mode, provider type, cost, and payment mechanism. Using stratified random sampling, 600 self-caring and functionally impaired older adult individuals (Barthel Index ≤60 for the functionally impaired) from an urban city were enrolled. After excluding incomplete responses, 579 valid questionnaires were analyzed, comprising 218 self-caring, 231 moderately disabled, and 130 severely disabled older adult. Data analysis was performed using a conditional logit model. Results: The conditional logit model analysis revealed that the level of disability significantly influenced service preferences. Moderately disabled individuals exhibited significant preferences for service upgrade packages (β=0.164) and partial reimbursement (β=0.329), with a willingness-to-pay (WTP) of 149.37 CNY for the upgrade package. In contrast, severely disabled individuals demonstrated significant preferences for institutional care (β=0.153) and partial reimbursement (β = 0.308), exhibiting a WTP for institutional care as high as 899.56 CNY, which is eight times that of the self-caring group (111.59 CNY). All groups expressed aversion to care provided by nursing aides (β=-0.331 to -0.617), requiring compensation ranging from 322.47 CNY (self-caring) to 1949.40 CNY (severely disabled) to accept such services. Conclusion: This study demonstrates that the level of disability is a key determinant of care preferences among the older adult, characterized by an evolution in demand from "life support" to "professional medical care." We recommend establishing a tiered care system: providing a "home-based + upgraded services" model as the core for moderately disabled individuals, and creating a service network dominated by "institutional + professional medical care" for the severely disabled, complemented by a sliding-scale payment mechanism that prioritizes coverage for professional services under long-term care insurance. This approach aims to achieve precise allocation of care resources.