Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment

  • T. Lehnert
  • O. H. Günther
  • A. Hajek
  • S. G. Riedel-Heller
  • H. H. König
Original Research



Most people prefer to “age in place” and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care.


To investigate preferences for home- and community-based long-term care services packages.


Discrete choice experiment conducted in mailed survey.

Setting and participants

Randomly selected sample of the general population aged 45–64 years in Germany (n = 1.209).

Main variables studied

Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2–4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment.


Quality of care was the most important attribute to respondents and small teams of regular caregivers (1–2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98.


Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.


Preferences Discrete choice experiment Long-term care Old age assistance 

JEL Classification

I13 I18 I19 



This work was supported by the German Federal Ministry of Education and Research (BMBF) (Grant Number: 01EH1101B).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The study was approved by the responsible ethics committee (Ethik-Kommission der Ärztekammer Hamburg; PV4781) prior to beginning the project. Participants provided their explicit oral informed consent during the recruitment phase by agreeing to participate (providing a mail/e-mail address). Oral consent is common in survey research in Germany; the ethical guidelines of the International Code of Marketing and Social Research Practice by the International Chamber of Commerce and the European Society for Opinion and Marketing Research were followed. Recruited individuals gave implicit consent by returning the questionnaire. Personally identifying information were not collected and participant responses were anonymized prior to analysis.

Supplementary material

10198_2018_968_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31 kb)
10198_2018_968_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOCX 22 kb)
10198_2018_968_MOESM3_ESM.docx (19 kb)
Supplementary material 3 (DOCX 19 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Health Economics and Health Services Research, Hamburg Center for Health EconomicsUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Institute of Social Medicine, Occupational Health and Public HealthUniversity of LeipzigLeipzigGermany

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