Willingness to pay for emergency referral transport in a developing setting: a geographically randomized study

Area of Science:

• Public Health
• Health Economics
• Rural Health Services Research

Background:

• Access to emergency medical transport is crucial, especially in rural areas.
• Understanding willingness to pay (WTP) for ambulance services is vital for resource allocation in low-income settings.
• Guatemala faces challenges in providing equitable healthcare access, particularly for rural populations.

Purpose of the Study:

• To identify socioeconomic and demographic correlates of WTP for ambulance transport in Santiago Atitlán, Guatemala.
• To analyze how emergency severity influences WTP for ambulance services.
• To inform public health planning and subsidy allocation for referral ambulance transport.

Main Methods:

• Utilized novel randomization and satellite imagery for household selection in Santiago Atitlán.
• Employed a price ladder method to elicit WTP based on emergency severity (life-threatening, disability-causing, simple).
• Applied simple and multiple linear regression to identify correlates and predict demand for ambulance transport.

Main Results:

• Household income, rural residence, and education levels were significant correlates of WTP.
• WTP varied significantly by emergency severity, with higher WTP for life-threatening emergencies.
• WTP was more responsive to price changes for disability-causing emergencies compared to life-threatening ones.

Conclusions:

• Household income, rural location, and education are primary determinants of WTP for ambulance transport.
• Emergency severity is a critical factor influencing WTP, highlighting the need for differentiated pricing or subsidies.
• WTP data can guide resource-poor settings in developing equitable and economically efficient ambulance service pricing and subsidy strategies.