Patients' willingness to pay for health care quality improvement under universal healthcare coverage in Egypt.

Background: In economics, the word "willingness to pay" refers to the highest amount that an individual would be willing to pay, give up, or exchange to obtain goods or services or to avoid something undesirable. It can be applied in healthcare as a way to evaluate the worth of improving the quality of health services. This study aims to assess patients' willingness to pay (WTP) for healthcare quality improvement among hospitalized patients in two hospitals in Egypt.

Methods: Four-hundred and twenty-six patients were asked to provide a rating for different quality attributes. Patients were presented with a hypothetical scenario and asked about their WTP for a monthly insurance premium to benefit from improving each quality attribute. WTP was elicited using the payment card (PC) response format.

Results: Fifty-two percent of studied patients were not willing to pay to improve healthcare quality attributes. Fifty percent of those who were willing to pay were certain to pay. The most commonly stated reasons for unwillingness to pay were "being governmental responsibility" and "household cannot afford" (43% and 36.8%, respectively). Patients were willing to pay the highest amount of money to improve the quality attributes "competence," followed by "outcome" and "doctor-patient relationship" (491.03, 465, and 423 LE, respectively). For all quality attributes, except for waiting time and availability of supplies and equipment, the amount of money the patients were willing to pay increased significantly as the perceived quality of that attribute reduced. Advancing age had a significant negative association with WTP (p = 0.002). Also, advancement in education was associated with significantly higher WTP (p < 0.001). Those with health expenditures ranging from 2000 to < 6000 LE per month were 3.38 times more willing to pay than those with health expenditures ranging from 200 to 1000 LE (p < 0.001).

Conclusion: WTP for quality improvement among study participants was low, being the lowest among the elderly and lower-educated individuals. Community financing should not be a method for funding quality improvements except for a few quality attributes such as doctor-patient communication and increased doctor competence. This should be coupled with clear exemption criteria for those unable to pay.