Abstract
朱娟,黄慧瑶,毛阿燕,孙宗祥,邱五七,雷海科,董佩,黄佳文,白亚娜,孙晓杰,刘国祥,王德斌,廖先珍,任建松,郭兰伟,兰莉,周琦,宋冰冰,刘玉琴,杜灵彬,朱琳,曹蓉,王家林,买玲,任英,周金意,孙校华,吴寿岭,齐啸,娄培安,蔡波,李霓,张凯,赫捷,代敏,石菊芳.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[J].Chinese journal of Epidemiology,2018,39(2):157-164
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
Received:August 26, 2017  
DOI：10.3760/cma.j.issn.0254-6450.2018.02.005
KeyWord: 肿瘤  联合筛查  筛查频率  支付意愿  可持续性
English Key Word: Neoplasms  Packaging screening  Screening frequency  Willingness-to-pay  Sustainability
FundProject:国家自然科学基金（81773521，81402740）；WHO2016-2017双年度合作项目（2016/664439-0）；科技部重大慢性非传染性疾病防控专项（2017YFC1308700，2017YFC1308705）；中国医学科学院医学与健康科技创新工程项目（2017-I2M-1-006）；国家科技重大专项（2017ZX10201201-008-002）；国家重大公共卫生服务项目——城市癌症早诊早治项目
Author NameAffiliationE-mail
Zhu Juan National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Huang Huiyao National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Mao Ayan Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Sun Zongxiang Harbin Center for Disease Control and Prevention, Harbin 150056, China  
Qiu Wuqi Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Lei Haike Chongqing Cancer Institute, Chongqing 400030, China  
Dong Pei Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Huang Jiawen Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Bai Yana Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China  
Sun Xiaojie Center for Health Management and Policy of Shandong University, Jinan 250012, China  
Liu Guoxiang Harbin Medical University, Harbin 150081, China  
Wang Debin School of Medical Administration, Anhui Medical University, Hefei 230032, China  
Liao Xianzhen Hunan Provincial Cancer Hospital, Changsha 410006, China  
Ren Jiansong National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Guo Lanwei Henan Cancer Hospital, Zhengzhou 450008, China  
Lan Li Harbin Center for Disease Control and Prevention, Harbin 150056, China  
Zhou Qi Chongqing Cancer Institute, Chongqing 400030, China  
Song Bingbing Affiliated Cancer Hospital of Harbin Medical University, Harbin 150081, China  
Liu Yuqin Gansu Provincial Cancer Hospital, Lanzhou 730050, China  
Du Lingbin Zhejiang Cancer Hospital, Hangzhou 310022, China  
Zhu Lin Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China  
Cao Rong Guangdong Provincial Institute of Public Health, Guangzhou 511430, China  
Wang Jialin Shandong Tumor Hospital, Jinan 250117, China  
Mai Ling Henan Cancer Hospital, Zhengzhou 450008, China  
Ren Ying Tieling Central Hospital, Tieling 112000, China  
Zhou Jinyi Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China  
Sun Xiaohua Ningbo No.2 Hospital, Ningbo 315010, China  
Wu Shouling Kailuan General Hospital, Tangshan 063000, China  
Qi Xiao Tangshan People's Hospital, Tangshan 063001, China  
Lou Peian Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, China  
Cai Bo Nantong Tumor Hospital, Nantong 226000, China  
Li Ni National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Zhang Kai National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
He Jie National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Dai Min National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Shi Jufang National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China shijf@cicams.ac.cn 
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Abstract:
      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。
English Abstract:
      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.
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