Exploring Parents’ Willingness to Pay for an Out-of-Pocket Developmental Assessment for Children

Background

In Taiwan’s publicly funded child developmental assessment system(CDAS), long waits have become a practical service issue. This study used willingness to pay (WTP) to quantify how caregivers value faster access and to examine factors associated with WTP.

Methods

A cross-sectional caregiver survey was conducted from October 2025 to May 2026 at three institutions in northern Taiwan (n = 252). A hypothetical CDAS incorporating parent preferences based on a prior qualitative study was developed. WTP was evaluated by contingent valuation through a caregiver survey on assessment experiences and preferences. Multivariable OLS models examined associations between WTP and waiting-time category (<3 months, 3-6 months, >6 months), perceived household financial status, child and caregiver background variables, and service-experience variables. We also estimated marginal effects and interaction-based predicted WTP.

Results

Estimated mean WTP ranged from NTD 4,894.6 (SD 4,137.9) to NTD 6,612.5 (SD 4,771.4). The interaction between household financial status and actual waiting time of 3-6 months was statistically significantly associated with WTP (beta= 6,342.6 (p=.017) and 7,204.8 (p=.009) respectively. Predicted WTP patterns differed across financial-status groups: households with low financial status remained at lower predicted WTP across waiting categories; households with neutral financial status showed higher predicted WTP when waiting exceeded six months; and households with high financial status showed the highest predicted WTP for those with actual waiting time being 3-6 months, followed by a decline in the effect of actual waiting time.

Conclusions

Caregivers showed measurable WTP for faster CDAS, and WTP varied by waiting time and household financial status. The finding suggest that policy may consider a self-paid fast-track assessment option, with subsidies for lower-income families who choose this option.

Key messages

• The study quantifies family demand for faster child developmental assessment in a publicly funded setting.

• The findings may inform countries with similar publicly funded child assessment systems when designing waiting-time and subsidy policies for children and families.