Determinants of willingness to pay for self-paid vaccines in China

Background: While vaccines not covered by China's Expanded Program on Immunization can be received voluntarily with out-of-pocket payment, the uptake of self-paid vaccines in China is low. Objective: To investigate willingness to pay (WTP) for self-paid vaccines and its determinants in China. Methods: We interviewed 2160 randomly selected households with children 0-3 years old, in 108 communities from three provinces in 2013. A bidding game method was used to elicit WTP for two self-paid vaccines: 7-valent pneumococcal conjugate vaccine and influenza vaccine. We conducted multivariate linear regressions to determine factors affecting the WTP. Results: Median WTP for pneumococcal conjugate vaccine and influenza vaccine were Chinese Yuan 200 and 60 (10 US Dollars). 92% and 55% of respondents, respectively were not willing to pay the market price for these two vaccines. Lower price barrier and higher ability to pay were associated with higher WTP. Those with better vaccine or disease-related knowledge, higher perceived vulnerability and severity of diseases were willing to pay more. However, perceived effectiveness and safety barriers to vaccination had no significant effects on the WTP. Recommendations from peers and healthcare providers increased the WTP. Fathers and grand parents of children had a higher WTP than their mothers. The WTP decreased with age, but was not affected by education and occupation. Conclusions: The majority of individuals, in our study, were not willing to pay the market price for self-paid vaccines against high-burden diseases in China. The economic barriers to vaccination should therefore be removed to increase the demand. Region-specific information about disease burden, fiscal capacity and cost-effectiveness is important for the development of local financing policy in order to cover vaccination costs. Interventions targeting psychosocial factors, such as health education and communication with providers and peers, could also be effective in increasing the uptake of these vaccinations.