Willingness and ability to pay for healthcare insurance: A cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)
Open Access
- 24 November 2021
- journal article
- health economics
- Published by Public Library of Science (PLoS) in PLOS Global Public Health
- Vol. 1 (11), e0000057
- https://doi.org/10.1371/journal.pgph.0000057
Abstract
Willingness and ability to pay for insurance that would cover primary healthcare services has not been evaluated consistently in different African communities. We conducted a cross-sectional community health survey and examined willingness and ability to pay in 3676 adults in seven communities in four countries: Nigeria, Tanzania, Uganda and Kenya. We used an open-ended contingency valuation method to estimate willingness to pay and examined ability to pay indirectly by calculating the ratio of healthcare expenditure to total household income. Slightly more than three quarters (78.8%) of participants were willing to pay for a health insurance scheme, and just a little above half (54.7%) were willing to pay for all household members. Across sites, median amount willing to pay was $2 per person per month. A little above half (57.6%) of households in Nigeria were able to pay the premium. The main predictors of likelihood of being unwilling to pay for the health insurance scheme were increasing age [aOR 0.99 (95% CI 0.98, 1.00)], being female [0.68 (0.51, 0.92], single [0.32 (0.21, 0.49)], unemployment [0.54 (0.34, 0.85)], being enrolled in another health insurance scheme [0.45 (0.28, 0.74)] and spending more on healthcare [1.00 (0.99, 1.00)]. But being widow [2.31 (1.30, 4.10)] and those with primary and secondary education [2.23 (1.54, 3.22)] had increased likelihood of being willing to pay for health insurance scheme. Retired respondents [adjusted mean difference $-3.79 (-7.56, -0.02)], those with primary or secondary education [$-3.05 (-5.42, -0.68)] and those with high healthcare expenditure [$0.02 (0.00, 0.04)] predicted amount willing to pay for health insurance scheme. The willingness to pay for health insurance scheme is high among the seven communities studied in East and West Africa with socio-demography, economic and healthcare cost as main predictive factors.Funding Information
- Harvard T.H. Chan School of Public Health (BLSCHP-1707)
This publication has 15 references indexed in Scilit:
- Social health insurance schemes in Africa leave out the poorInternational Health, 2018
- Universal health coverage, economic slowdown and system resilience: Africa’s policy dilemmaBMJ Global Health, 2017
- Knowledge, Practice and Willingness to Participate in Community Health Insurance Scheme among Households in Nigerian Capital CitySudan Journal of Medical Sciences, 2017
- Strengthening health systems for universal health coverage and sustainable developmentBulletin of the World Health Organization, 2017
- Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income CountriesPLOS ONE, 2016
- Predictors of Willingness to Participate in Health Insurance Services among the Community of Jimma Town, Southwest EthiopiaHealth Services Insights, 2014
- Community perceptions of health insurance and their preferred design features: implications for the design of universal health coverage reforms in KenyaBMC Health Services Research, 2013
- The progressivity of health-care financing in KenyaHealth Policy and Planning, 2013
- Development of Micro, Small and Medium Enterprises and Their Constraints: A Story from IndonesiaGadjah Mada International Journal of Business, 2011
- Willingness to pay for voluntary health insurance in Tanzania.2011