Preferences for home-based care services during China's long-term care market transition: evidence from a discrete...

With population aging and the weakening of traditional family caregiving, home-based care services are becoming more important in China. However, little is known about residents' service preferences during the transition from informal to formal care systems in the context of the long-term care insurance system.

This study examines the preferences of Chinese residents aged 25 or above for home-based care services, focusing on the relative importance of key service attributes, willingness to pay, and preference heterogeneity across demographic groups.

A discrete choice experiment (DCE) was conducted from September 2024 to January 2025, with 680 valid responses from 21 provinces in China we're included for analysis. Five attributes were identified through literature review, expert consultations, and focus group interviews: nursing program, service attitude of nursing staff, professional competence of nursing staff, type of service organization and monthly cost. A mixed logit model analyzed preference patterns and heterogeneity.

For respondents, the service attitude of nursing staff (relative importance 29.59%), and the nursing program (29.30%) are of almost equal importance, followed by the monthly cost (20.62%). Respondents showed the highest willingness to pay for a good service attitude. Unmarried individuals, those without children, and non-public sector employees had stronger preferences for service quality and brand reputation, reflecting the role of social support networks and welfare systems in shaping formal care preferences.

Findings reveal that home-based care preferences in China are shaped by the dynamic interplay between formal care systems and informal support networks. While the availability of informal support influences individuals' reliance on formal services, the design, quality, and institutional credibility of formal care options also play a key role in shaping preferences. Together, these factors jointly shape how people evaluate and choose home-based care services during China's long-term care market transformation. The observed heterogeneity underscores the need for differentiated service models and policy responses tailored to diverse levels of social and institutional support.