我国城市居民对多种癌症联合筛查的频率倾向及支付意愿

Preference on screening frequency and willingness-to-pay for multiple-cancer packaging screening programs in urban populations in China

目的 了解我国城市居民对常见癌种（肺、胃、食管、肝、结直肠和乳腺癌）联合筛查的频率倾向及支付意愿。方法 2012-2014年基于城市癌症早诊早治项目的13个省份现场，面对面调查不同付费假设下，实际参加项目的居民倾向的筛查频率、对长期推行每3年1次联合筛查的支付意愿和支付额度等。结果 最终完成合格访谈31 029人，年龄（55.2±7.5）岁，近5年家庭人均年收入M值为2.5万元。对于多种癌症联合筛查服务，若完全免费，93.9%的居民选择每1~3年1次的频率；完全自费时对应的比例为67.3%。假设将每3年1次的联合筛查长期推行且需个人部分付费时，76.7%的居民愿意付费，但支付额度超过500元者（联合筛查人均费用约1 500元）仅占11.2%。其余23.3%无支付意愿者主要认为费用难以承受（71.7%）和认为没必要筛查（40.4%）。结论 我国城市参加过癌症筛查的居民对多种癌症联合筛查倾向＂高频＂模式，提示大范围推广的潜在接受程度较高，但需科学评价与正确引导。尽管多数居民对联合筛查有支付意愿但支付额度有限，提示应加强居民对自我健康的责任管理意识，建立筛查服务共付机制时应设置合理比例。

Objective From an actual cancer screening service demanders＇ perspective, we tried to understand the preference on screening frequency and willingness-to-pay for the packaging screening program on common cancers and to evaluate its long-term sustainability in urban populations in China. Methods From 2012 to 2014, a multi-center cross-sectional survey was conducted among the actual screening participants from 13 provinces covered by the Cancer Screening Program in Urban China （CanSPUC）. By face-to-face interview, information regarding to preference to screening frequency, willingness-to-pay for packaging screening program, maximum amount on payment and related reasons for unwillingness were investigated. Results A total of 31 029 participants were included in this survey, with an average age as （55.2±7.5） years and median annual income per family as 25 000 Chinese Yuan. People＇s preference to screening frequency varied under different assumptions （＂totally free＂ and ＂self-paid＂）. When the packaging screening was assumed totally free, 93.9% of residents would prefer to take the screening program every 1 to 3 years. However, the corresponding proportion dropped to 67.3% when assuming a self-paid pattern. 76.7% of the participants had the willingness-to-pay for the packaging screening, but only 11.2% of them would like to pay more than 500 Chinese Yuan （the expenditure of the particular packaging screening were about 1 500 Chinese Yuan）. The remaining 23.3% of residents showed no willingness-to-pay, and the main reasons were unaffordable expenditure （71.7%） and feeling ‘no need’ （40.4%）. Conclusions People who participated in the CanSPUC program generally tended to choose high-frequency packaging screening program, indicating the high potential acceptance for scale-up packaging screening, while it needs cautious assessments and rational guidance to the public. Although about seven in ten of the residents were willing to pay, the payment amount was limited, revealing the necessity of strengthening individual＇s awareness of his or her key role in health self-management, and a reasonable payment proportion should be considered when establishing co-compensation mechanism.