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In Japan over the past few years, more attention has been focused on unnoticed solitary death in the context of an aging society and the trend toward nuclear family. A number of institutions and companies have implemented a prevention measure with digital terrestrial broadcasting telecare services for the elderly: Hokkaido University; TV-Asahi Corporation; Hitachi, Ltd; Iwamizawa City; Hokkaido Television Broadcasting Co, Ltd; and Hamanasu Information Co, Ltd. Although this system is provided free of charge as a demonstration test, determining the appropriate price for the service is required for its sustainable operation.
The aim of this study was to quantify individual willingness to pay (WTP) so as to test the tenability of digital terrestrial broadcasting service for elderly telecare.
We used the contingent valuation method (CVM) to estimate the WTP for this service among 305 citizens (valid response rate 76.0%) living in Japan. A questionnaire survey was conducted for people aged 18 to 100 years according to Japanese age distribution from September 2016. To elicit WTP, we adopted a
The median WTP for this service’s monthly fee is estimated to be 431 JPY (approximately US $3.7). The finding suggests that gender (0.66,
We conclude that reliable WTP was elicited by CVM based on an Internet survey. Calculated median WTP for digital terrestrial broadcasting service for elderly telecare was 431 JPY (approximately US $3.7). In the analysis of factors that affect WTP,
Japanese society has been known as an aging society. Coulmas defined the percentage of an aging society as follows: “There are three different types of societies based on the proportion of elderly. Aging society: 7-14% of the population are 65 years or older. Aged society: 14-21% of the population are 65 years or older. Hyper-aged society: 21% or more of the population are 65 years or older.” [
One of the biggest issues among aging societies is unnoticed isolated death. According to the Tokyo medical examiner’s office [
Although surveys about isolated elderly deaths in Japan have not been conducted, in Tokyo alone, 1973 males and 1143 elderly females were found after their death in their home, reported by Tokyo Medical Examiner’s Office. Moreover, 15,603 unnoticed isolated deaths were found in Japan more than 4 days after their death, reported by the Ministry of Internal Affairs and Communication [
Social cost of unnoticed isolated death.
Payer | Price, JPY (US $) | |
Removing fluids and filth of decayed body | 20,000-350,000 (173-3040) | |
Elimination of pest | 15,000-50,000 (129-434) | |
Deodorize and disinfect | 20,000-100,000 (173-868) | |
Property value goes down | ||
If it’s a public residence and has no guarantor for the room, all expenses above become public expenditure | ||
Administrative autopsy | 250,000-500,000 (2162-4325) | |
Police (increase of work load) | ||
Reregistration of individual record, cremation, cleaning out their belongings, etc |
Autopsy cost is mentioned as a public expenditure. However, this cost can be avoided if a death certificate is issued by the hospital, and thus, the early finding of disorder before death would save government expenses. The government [
In Iwamizawa City, Hokkaido, Japan, in cooperation with Hokkaido University; TV-Asahi Corporation; Hitachi, Ltd; Iwamizawa City; Hokkaido Television Broadcasting Co, Ltd; and Hamanasu Information Co, Ltd, have been conducting demonstration experiments of elderly telecare services using the Internet and digital terrestrial broadcasting to enhance health consciousness of the elderly and to improve elderly telecare [
About participation in this project, we connected the Internet to the television at the homes of participants who gave agreement. After issuing the participant’s user ID and password on the dedicated system, we made an Internet connection of the participant’s television and personal ID setting to their television. Registered TV in this study refers to a television that is ready to receive telecare services after personal ID setting is completed. The initial setting operation flow is shown in
In this service, when a registered TV is not used for 3 days, the call center will make a confirmatory telephone call to the registered individual, and if the individual cannot be reached, then the neighborhood association and civil servant committee will visit the registered location to make sure the individual is not in any fatal situation. Other than the elderly telecare function, this service also offers information about health care, local events, and doctors on duty in local hospitals (
Although this system has been provided free of charge as a demonstration test, obtaining a certain level of return of economic investment is required for the sustainable operation of this service. The aim of this study was to quantify individual willingness to pay (WTP) measures of a digital terrestrial broadcasting service for elderly telecare.
Operational flow to start.
Contents of elderly telecare service.
Elderly telecare service.
In this study, we used the contingent valuation method (CVM) to quantify individual WTP, which is widely used in economic evaluations [
Question price patterns in JPY (US $).
Price-first question, JPY(US $) | Upper price-second question (first question: yes) | Lower price-second question (first question: no) |
500 (4.3) | 750 (6.5) | 250 (2.1) |
1000 (8.6) | 1500 (13.0) | 500 (4.3) |
2000 (17.3) | 2500 (21.7) | 1500 (13.0) |
3000 (25.9) | 3500 (30.4) | 2500 (21.7) |
We decided to conduct an Internet survey because it is more cost-efficient and faster than mail or face-to-face interviews. A total of 400 Japanese citizens ranging from 18 to 100 years of age were chosen to participate in this survey. However, to reflect the Japanese population [
Definitions of age distribution.
Definitions | Age (years) | Description |
Younger | 18-39 | Low WTPa for service because they have no experience or need for this service |
Middle | 40-65 | High WTP for service because this generation is mostly like to have parents older than 65 years, and so, they are willing to pay more |
Elderly | Over 65 | Potential users of this service who are older than 65 years can have a higher WTP because demand is relatively higher than the other age groups |
aWTP: willingness to pay.
Definition of population distribution in urban areas.
Urban area | City name | Population | Area (km²) | Population density (people/km²) |
Sapporo area | Sapporo | 2,584,880 | 4514 | 573 |
Sendai area | Sendai | 2,169,757 | 5970 | 363 |
Kanto area | Saitama, Chiba, Tokyo, Yokohama, Kawasaki, and Sagamihara | 36,923,193 | 14,034 | 2631 |
Niigata area | Niigata | 1,421,694 | 5345 | 266 |
Shizuoka and Hamamatsu area | Shizuoka, Hamamatsu | 2,741,028 | 4982 | 550 |
Chukyo area | Nagoya | 9,107,414 | 7072 | 1288 |
Kinki area | Kyoto, Osaka, Sakai, Kobe | 19,341,976 | 13,033 | 1484 |
Okayama area | Okayama | 1,647,892 | 3637 | 453 |
Hiroshima area | Hiroshima | 2,099,514 | 5048 | 416 |
Kita-Kyushu area, Fukuoka area | Kita-Kyushu, Fukuoka | 5,515,427 | 5731 | 962 |
Utsunomiya area | Utsunomiya | 1,086,898 | 5455 | 199 |
Matsuyama area | Matsuyama | 717,687 | 2272 | 316 |
Kumamoto area | Kumamoto | 1,476,435 | 4251 | 347 |
Kagoshima area | Kagoshima | 1,152,748 | 3458 | 333 |
We used a double-bound dichotomous logit model; median WTP is estimated as a representative value. Median indicates that 50.0% of the respondents agree with the offered amount [
The model includes all variables.
Expected effects to willingness to pay (WTP).
Validation questions | Details |
I agree to this project but I don’t think it’s worth paying. | Valid answer |
I would like to use this service but I can’t afford it. | Valid answer |
I could not decide with this information. | Invalid answer |
Even if it’s free to use, I don’t think it’s worth paying. | Valid answer |
Write your own reason if any ( ). |
The questionnaire for excluding invalid answers.
Factor | Affect to WTPa | |
Age | Health risk goes up as people get older; therefore, WTP is likely to increase | |
Male | Not significant | |
Female | ||
Living alone | If respondents live alone, they would feel necessary to use telecare service; therefore, WTP is likely to increase | |
Living with 2 or more people | ||
More than 8 million JPY | The more income they have, the more money they can consume | |
Less than 8 million JPY | ||
Yes | If respondents have an acquaintance who lives alone, they would feel the necessity of a telecare service; therefore, WTP is likely to increase | |
No | ||
Yes | If respondents are health conscious, they could give this system a good reputation; therefore, WTP is likely to increase | |
No | ||
Yes | If respondents have willingness to use, they would agree to pay | |
No | ||
Yes | If respondents have anxiety regarding their health, they would feel the necessity of a telecare service | |
No | ||
Yes | If respondents go a week without seeing anyone, they could be in a state of social isolation in the local community and consider the risk of dying alone | |
No |
aWTP: willingness to pay.
Regarding questionnaire design (
The response rate of this questionnaire was 100%, but 95 answers were excluded because of invalid answers. Therefore, 305 (76%;
According to our initial calculation, the WTP average was calculated to be 1525 JPY (US $13.1). However, this figure is inaccurate, as it does not take into account the concern of overvaluation. As a general countermeasure, it is recommended to cut the hem with the maximum WTP [
Basic properties (305 valid responses).
Characteristics | Sample, n (%) | |
Male | 191 (63) | |
Female | 114 (37) | |
18-39 | 82 (27) | |
40-64 | 123 (40) | |
Over 65 | 100 (33) | |
Living alone | 67 (22) | |
Living with spouse | 97 (32) | |
Living with spouse and child or children | 106 (35) | |
Single father or mother or living with a married child | 3 (1) | |
Three or more generations | 21 (7) | |
Others | 11 (3) | |
Lower than 2 million | 51 (17) | |
2-4 million | 86 (28) | |
4-6 million | 71 (23) | |
6-8 million | 41 (13) | |
8-10 million | 33 (11) | |
10+ million | 23 (8) |
Factor summary.
Factors | Sample, n (%) | |
18-39 | 82 (27) | |
40-64 | 123(40) | |
Over 65 | 100(33) | |
Male | 191 (63) | |
Female | 114 (37) | |
Living alone | 67 (22) | |
Living with someone | 238 (78) | |
More than 8 million | 56 (18) | |
Less than 8 million | 249 (72) | |
Yes | 105 (34) | |
No | 200 (66) | |
Yes | 258 (84) | |
No | 47 (16) | |
Yes | 158 (51) | |
No | 147 (49) | |
Yes | 113 (37) | |
No | 192 (63) | |
Yes | 19 (6) | |
No | 286 (94) |
Summary of price patterns.
Price in JPY (US $) | Yes-Yes | Yes-No | No-Yes | No-No |
500 (4.3) | 20 | 9 | 16 | 33 |
1000 (8.6) | 16 | 13 | 17 | 35 |
2000 (17.3) | 11 | 6 | 0 | 59 |
3000 (25.9) | 10 | 5 | 4 | 51 |
Estimated willingness to pay (WTP).
Willingness to pay | Price in JPY/month (US $) |
Median | 431 (3.7) |
Average | 1525 (13.1) |
Average (truncated at the maximum bid) | 809 (6.9) |
Estimated parameters of the willingness to pay (WTP) model.
Variables | Parameter (standard error) | Variance inflation factor | |
Constant: alpha | 5.312 (0.846) | <.001 | |
Log(bid) | −1.310 (0.121) | <.001 | 1.036 |
Health consciousness | 1.086 (0.439) | .01 | 1.039 |
Gender | 0.667 (0.272) | .01 | 1.004 |
Willingness to use | 2.388 (0.303) | .001 | 1.036 |
See others less than once a week | 1.003 (0.528) | .06 | 1.029 |
If we look at the comparison between different generations (
Estimated willingness to pay (WTP) model.
CI of willingness to pay (WTP) for different generations.
CI of willingness to pay (WTP) for urban and nonurban area.
In analysis of factors affecting WTP, variables with significant changes will be isolated and analyzed in more detail (
Analysis of all factors that affect willingness to pay (WTP).
Variables | Parameters | |
Constant | 5.346 | <.001 |
log(bid) | −1.326 | <.001 |
Gender | 0.669 | .02 |
Age | −0.003 | .67 |
Living alone | 0.281 | .40 |
High income | 0.187 | .57 |
Having an acquaintance who lives alone | 0.199 | .47 |
Health consciousness | 1.011 | .03 |
Willingness to use | 2.422 | <.001 |
Anxiety to health | 0.354 | .20 |
See others less than once a week | 0.852 | .12 |
Analysis with only isolated factors that affect willingness to pay (WTP).
Variables | Parameters | |
Constant | 5.312 | .001 |
ln (offer amount) | −1.310 | .001 |
Gender | 0.667 | .01 |
Interest in health | 1.086 | .01 |
Willingness to pay to service | 2.388 | .001 |
See others less than once a week | 1.003 | .06 |
According to our research, the estimated median WTP is 431 JPY (US $3.7) per month, and the mean is 809 JPY (US $6.9) per month. It would be greatly beneficial if there were other similar research studies available for comparison. Unfortunately, WTP research for this service is first of its kind, which limited us from comparing with previous research. As the second best alternative, we decided to use figures of similar services to compare the practicality and validity of our research finding. Similar services (
Compared with our finding, the prices listed above are more expensive. WTP only represents utility of consumers. However, services provided by privately owned enterprises need to retrieve costs and make a profit on top of the consumer utility. It is worth mentioning that care services are offered by the security company, Secom Ltd, for 300 JPY (US $2.5) per month. Although 300 JPY may seem less costly compared with any other services, this service is provided as an optional service of top of home security services for 5900 JPY (US $51.0) per month. If singled out, the service provided by Secom Ltd is likely to be higher than other services.
There is also a free periodic phone call service provided by Mitaka City in Tokyo but, although it is free of charge, it does not indicate that it is free to run and operate. The only reason this service can exist and continue existing is because of the direct financial support from the government in the form of taxes paid by the general public. In addition to government financial support, Mitaka City does not send any personnel to make home visits, which significantly cuts the cost on human resources.
In conclusion, the WTP figure of 431 JPY (US $3.7) per month is valid. We can make this conclusion because this figure is lower than all privately owned enterprises yet higher than public services provided by Mitaka City.
Price comparison with similar services.
Looking at different age groups, we notice a factor in significant difference in WTP comes from one of the three age groups.
According to the research done by the Ministry of Internal Affairs and Communications, unnoticed solitary death is higher in urban than in nonurban areas [
During research, we found six different variables that affect the final WTP estimation:
For the factor see others less than once a week, it is possible that they do not participate in the local society, so they found our project offering information about the local community and telecare service useful.
The technology acceptance model (TAM) is widely used as a model to analyze factors that people accept new technologies and services. In this model, four factors,
Hirose et al are conducting research using TAM for responses to mHealth application on health behavior [
In this research, we were conducting a questionnaire survey in temporary environments; hence, we cannot clarify what factors and performance are affecting the WTP. Analysis of customer satisfaction and physical satisfaction using a service quality model such as the Kano model is needed. On the basis of the analysis results, we believe that it is necessary to consider the acceptance price, taking the quality of service into account.
This research was conducted using an Internet survey; therefore, it is possible that there is bias [
The double-bound dichotomous choice method used in this study may cause yes-saying bias. It also has the possibility of causing anchoring bias, in which the answer depends on the initial presentation amount. The point that it cannot fully cope with these tasks is considered to be one of the problems of CVM. On the basis of the theory of behavioral economics, we think that it is necessary to consider the WTP in a method not affected by the priming effect and the anchoring effect.
Chi-square test for gender distribution. χ220=104,
Gender and values | 18-29 years | 30-39 years | 40-49 years | 50-64 years | Over 65 years | Total | |
Observed value | 22 | 20 | 41 | 66 | 99 | 248 | |
Predicted value | 29 | 31 | 35 | 45 | 53 | 193 | |
Adjusted residual | −0.55 | −0.79 | 0.49 | 1.71 | 4.20 | ||
Observed value | 35 | 41 | 28 | 25 | 23 | 152 | |
Predicted value | 28 | 30 | 34 | 46 | 70 | 207 | |
Adjusted residual | 0.67 | 1.09 | −0.59 | −2.20 | −5.48 |
In this study, we conducted an Internet survey. Median WTP is estimated to be 431 JPY (US $3.7) per month, and mean WTP is estimated to be 809 JPY (US $6.9) per month. For comparison of WTP among age groups and differences between residential areas, the elderly group is estimated to be higher than other groups. In the analysis of factors that affect WTP,
contingent valuation method
information technology
variance inflation factor
willingness to pay
The authors would like to thank all those from TV-Asahi Corporation, Hitachi, Ltd, Iwamizawa City, Hokkaido Television Broadcasting Co, Ltd, and Hamanasu Information Co, Ltd, who supported and participated in this study.
None declared.