Unlocking Vision Care Accessibility: Evaluating Caregivers' Willingness to Pay in Specialised Eye Clinics for Family Members With Intellectual Disabilities.
Taiwanese caregivers value eye clinics for ID but won’t pay enough to keep them open.
01Research in Context
What this study did
The authors asked caregivers how much cash they would hand over for eye clinics made for people with intellectual disabilities.
They ran a survey in Taiwan under the same National Health Insurance prices clinics must charge.
The question: will families pay enough to keep these special eye services alive?
What they found
Caregivers said yes, but their price was too low.
The money they offered would not cover the real running cost of the clinics.
Without extra public funds, the doors would close.
How this fits with other research
Older Taiwan papers already show big bills. Chiang et al. (2013) found kids with ID average 20 outpatient visits a year and triple the medical costs of peers.
Lin et al. (2009) showed one in three families never even pick up the NHI premium subsidy they already qualify for.
That looks like a contradiction: families skip free money yet won’t pay more. The gap is timing. Subsidies arrive later; clinic fees are due at the desk.
Van Hanegem et al. (2014) in Singapore proved that when you remove both cost and travel barriers, screening jumps from 18 % to 89 %. Chiun-Ho et al. now show the flip side: leave the bill with families and uptake stalls.
Why it matters
If you write behaviour plans that need vision checks, plan on funding first. Ask case managers to lock in subsidies or third-party payers before you book the appointment. Track who pays, not just who needs care, so referrals don’t die at the front desk.
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02At a glance
03Original abstract
BACKGROUND: People with intellectual disabilities (IDs) require more vision care but encounter considerable challenges during eye examinations. Specialised clinics established specifically for people with IDs are generally limited. This study aims to evaluate primary family caregivers' willingness to pay (WTP) for specialised ophthalmology services designed for people with IDs. METHODS: Between 15 August and 5 October 2023, we conducted a face-to-face survey targeting primary family caregivers of people with IDs in two local authorities in Taiwan. We obtained a probability sample through stratified random sampling. A total of 657 family caregivers completed this survey, with a response rate of 82.6%. WTP was evaluated using a contingent valuation method in a hypothetical ophthalmology clinic conceptualised through a qualitative study. Two-part models were estimated. RESULTS: The WTP for specialised ophthalmology services designed for people with IDs varied from NT$96.9 (US$3.2) to NT$217.7 (US$7.3) for the lowest-income group (p < 0.001) and from NT$513.0 (US$17.1) to NT$648.6 (US$21.6) for the highest-income group (p < 0.001). Factors such as family income, self-reported financial satisfaction and concern for the ocular health of family members with IDs significantly influenced WTP. CONCLUSIONS: Caregivers' WTP is low relative to the minimum operational costs of specialised ophthalmology clinics within the Taiwanese National Health Insurance scheme. This finding highlights the need for public funding to support such clinics and ensure that they can address the vision health disparity observed between people with and without IDs.
Journal of intellectual disability research : JIDR, 2025 · doi:10.1111/jir.13210