Preferences and heterogeneity in care service needs among disabled older adults in an urban setting

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 adults 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 adults. 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. The findings provide crucial evidence for the accurate provision of care services in an aging society, contributing to the policy goal of "aging with security."