[Cost-benefit analysis of community based rehabilitation program using willingness to pay measured by the contingent valuation method].

OBJECTIVE There have been few studies on economic evaluation of publicly provided community health services in Japan. The purpose of the present investigation was to conduct a cost-benefit analysis of a community based rehabilitation program provided by municipalities, using the willingness to pay (WTP) measured by the contingent valuation method, a survey-based approach to measure the monetary valuation for the benefit. METHODS The study was held in 18 wards of Yokohama city. The cost per capita of the program in each ward was calculated using the data from a statement of accounts and a report of activities of public health nurses, other officials, and volunteers, in the 1999 fiscal year. The WTP for the program was measured by a survey of 631 people who participated in the programs held in October and November, 2000. The mean, median, and 95% CI of WTP were calculated as measures of the benefit. RESULTS The response rate of the survey was 73.4%. The mean and median WTP were yen 441 and yen 300 respectively, and the 95% CI ranged from yen 800 to yen 1,682. The WTP was negatively related to the duration of functional disability, and positively related to income. However, the WTP was not significantly related to self-perceived effectiveness of the program and the SF-36. The costs per capita without the cost of volunteers among 18 wards ranged from yen 2,079 to yen 6,732, and those with the cost of volunteers ranged from yen 3,289 to yen 8,366. The net benefit per capita was negative. CONCLUSIONS To conduct cost-benefit analyses of community based rehabilitation programs more precisely, it is necessary to measure the costs of medical care and long term care saved and the benefits to others (e.g. volunteers, community residents, etc.) and to assess the WTP so that various aspects of effectiveness (health and non-health benefits) are taken into account.