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van der Pol M, Watson V, Boyers D. Stability of Willingness to Pay: Does Time and Treatment Allocation in a Randomized Controlled Trial Influence Willingness to Pay? Med Decis Making 2024:272989X241249654. [PMID: 38738541 DOI: 10.1177/0272989x241249654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
BACKGROUND Willingness-to-pay (WTP) estimates are useful to policy makers only if they are generalizable beyond the moment when they are collected. To understand the "shelf life" of preference estimates, preference stability needs be tested over substantial periods of time. METHODS We tested the stability of WTP for preventative dental care (scale and polish) using a payment-card contingent valuation question administered to 909 randomized controlled trial participants at 4 time points: baseline (prerandomization) and at annual intervals for 3 years. Trial participants were regular attenders at National Health Service dental practices. Participants were randomly offered different frequencies (intensities) of scale polish (no scale and polish, 1 scale and polish per year, 2 scale and polishes per year). We also examined whether treatment allocation to these different treatment intensities influenced the stability of WTP. Interval regression methods were used to test for changes in WTP over time while controlling for changes in 2 determinants of WTP. Individual-level changes were also examined as well as the WTP function over time. RESULTS We found that at the aggregate level, mean WTP values were stable over time. The results were similar by trial arm. Individuals allocated to the arm with the highest scale and polish intensity (2 per year) had a slight increase in WTP toward the latter part of the trial. There was considerable variation at the individual level. The WTP function was stable over time. CONCLUSIONS The payment-card contingent valuation method can produce stable WTP values in health over time. Future research should explore the generalizability of these results in other populations, for less familiar health care services, and using alternative elicitation methods. HIGHLIGHTS Stated preferences are commonly used to value health care.Willingness-to-pay (WTP) estimates are useful only if they have a "shelf life."Little is known about the stability of WTP for health care.We test the stability of WTP for dental care over 3 y.Our results show that the contingent valuation method can produce stable WTP values.
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Affiliation(s)
- Marjon van der Pol
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK (MVDP, VW, DB)
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK (MVDP, VW, DB)
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK (MVDP, VW, DB)
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Krohn J, Bountogo M, Ouermi L, Sie A, Baernighausen T, Harling G. Challenges and achievements in the utilization of the health system among adolescents in a region of Burkina Faso particularly affected by poverty. BMC Health Serv Res 2023; 23:1080. [PMID: 37821943 PMCID: PMC10566072 DOI: 10.1186/s12913-023-10052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE Healthcare for adolescents receives little attention in low-income countries globally despite their large population share in these settings, the importance of disease prevention at these ages for later life outcomes and adolescent health needs differing from those of other ages. We therefore examined healthcare need and use among adolescents in rural Burkina Faso to identify reasons for use and gaps in provision and uptake. METHODS We interviewed 1,644 adolescents aged 12-20 living in rural northwestern Burkina Faso in 2017. Topics included healthcare need and satisfaction with care provided. We calculated response-weighted prevalence of perceived healthcare need and utilization, then conducted multivariable regression to look at predictors of need, realized access and successful utilization based on the Andersen and Aday model. RESULTS 43.7 [41.2 - 46.0] % of participants perceived need for healthcare at least once in the preceding 12 months - 52.0 [48.1 - 56.0] % of females and 35.6 [32.5 - 39.0] % of males. Of those with perceived need, 92.6 [90.0 - 94.3] % were able to access care and 79.0 [75.6 - 82.0] % obtained successful utilization. Need was most strongly predicted by gender, education and urbanicity, while predictors of successful use included household wealth and female guardian's educational attainment. CONCLUSION Healthcare utilization among adolescents is low in rural Burkina Faso, but mostly thought of as sufficient with very few individuals reporting need that was not linked to care. Future objective assessment of healthcare need could help identify whether our results reflect a well-functioning system for these adolescents, or one where barriers lead to low awareness of needs or low expectations for service provision.
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Affiliation(s)
- Joshua Krohn
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3, Marsilius-Arkaden, 69120, Heidelberg, Germany.
| | | | | | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Till Baernighausen
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3, Marsilius-Arkaden, 69120, Heidelberg, Germany
- Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Global Health, University College London, London, UK
| | - Guy Harling
- Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa
- Institute for Global Health, University College London, London, UK
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Rockers PC, Kiragu ZW, Onyango MA, Laing RO, Wirtz VJ. Willingness to pay brand premiums for generic medicines in Kenya: A bidding game experiment. Int J Health Plann Manage 2023; 38:1453-1463. [PMID: 37337315 DOI: 10.1002/hpm.3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/25/2022] [Accepted: 06/04/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Recent growth in the market share of higher priced branded generic medicines in low- and middle-income countries (LMICs) has raised concerns around affordability and access. We examined consumer willingness to pay (WTP) for branded versus unbranded generic non-communicable disease (NCD) medicines in Kenya. METHODS We randomly assigned NCD patients to receive a hypothetical offer for either a Novartis Access-branded medicine or for an unbranded generic equivalent. We then analysed WTP data captured using a bidding game methodology. RESULTS We found that WTP for Novartis Access medicines was on average 23% higher than for unbranded generic equivalents (p = 0.009). The WTP brand premium was driven almost entirely by wealthier patients. CONCLUSIONS Our findings suggest that the dominance of branded generics in LMICs like Kenya reflect in part consumer preferences for these medicines. Governments and other health sector actors may be justified in intervening to improve access to these medicines and equivalent non-branded generics, particularly for the poorest patients who appear to have no preference for branded medicines.
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Affiliation(s)
- Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Zana Wangari Kiragu
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Monica A Onyango
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Richard O Laing
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Girmaw F, Adane E, Kassaw AT, Ashagrie G, Baye T. Willingness to Pay for Social Health Insurance Among Health Care Professionals in North Wollo Zone, Amhara Region, Ethiopia: Mixed Method Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:593-606. [PMID: 37525718 PMCID: PMC10387270 DOI: 10.2147/ceor.s421461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Background Ethiopia introduced a social health insurance (SHI) scheme for the formal sector that will cost 3% of the monthly salary as a premium and provide universal health coverage. Since health care professionals (HCP) are the primary front-line service providers, their willingness to pay (WTP) for SHI may have a direct or indirect impact on how the programme is implemented. However, little is known about WTP for SHI among HCP. Objective To assess WTP for SHI and associated factors among government employee HCP in the North Wollo Zone, Northeast Ethiopia. Methods Using the contingent valuation method, a mixed approach and cross-sectional study design were applied. For the qualitative study design, in-depth interviews were performed with focal persons and officers of health insurance. Multistage systematic random sampling was used to select 636 healthcare professionals. Logistic regression analysis was used to determine independent predictors of WTP for SHI. Qualitative data were analyzed using thematic analysis. Results A response rate of 92.45% was achieved among the 636 participants, with 588 healthcare professionals completing the interview. The majority (61.7%) of participants were willing to join and pay the suggested SHI premium. Participants' WTP was significantly positively associated with the presence of under five years of children but their willingness to pay was significantly negatively associated with the female gender and increasing monthly salary. On the other hand, on the qualitative side, the amount of premium contribution, benefits package, and quality of service were the major factors affecting their WTP. Conclusion The majority of healthcare professionals were willing to pay for the SHI scheme, almost as much as the premium set by the government. This suggests proof that healthcare financing reform is feasible, particularly for the implementation of the SHI system.
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Affiliation(s)
- Fentaw Girmaw
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Ejigayehu Adane
- Department of Pharmacy, College of Health Science, Wollo University, Wollo, Ethiopia
| | - Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Getachew Ashagrie
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Tenaw Baye
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
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Nugraheni DA, Satibi S, Kristina SA, Puspandari DA. Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15017. [PMID: 36429734 PMCID: PMC9690347 DOI: 10.3390/ijerph192215017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND National Health Insurance (NHI) in Indonesia requires an appropriate cost-sharing policy, particularly for diseases that require the largest financing. This study examined factors that influence willingness to pay (WTP) for cost-sharing under the universal health coverage scheme among patients with catastrophic illnesses in Yogyakarta, Indonesia. METHODS This was a cross-sectional study using structured questionnaires through direct interviews. The factors related to the WTP for cost-sharing under the NHI scheme in Indonesia were identified by a bivariable logistic regression analysis. RESULTS Two out of every five (41.2%) participants had willingness to pay for cost-sharing. Sex [AOR = 0.69 (0.51, 0.92)], education [AOR = 1.54 (0.67, 3.55)], family size [AOR = 1.71 (1.07, 2.73)], occupation [AOR = 1.35 (0.88, 2.07)], individual income [AOR = 1.50 (0.87, 2.61)], household income [AOR = 1.47 (0.90, 2.39)], place of treatment [AOR = 2.54 (1.44, 4.45)], a health insurance plan [AOR = 1.22 (0.87, 1.71)], and whether someone receives an inpatient or outpatient service [AOR = 0.23 (0.10, 0.51)] were found to affect the WTP for a cost-sharing scheme with p < 0.05. CONCLUSION Healthcare (place of treatment, health insurance plan, and whether someone receives an inpatient or outpatient service) and individual socioeconomic (sex, educational, family size, occupational, income) factors were significantly related to the WTP for cost-sharing.
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Affiliation(s)
- Diesty Anita Nugraheni
- Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
| | - Satibi Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Diah Ayu Puspandari
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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Factors associated with health-seeking behavior amongst children in the context of free market: Household study in Ouagadougou, Burkina Faso, 2011. PLoS One 2022; 17:e0271493. [PMID: 36256647 PMCID: PMC9578640 DOI: 10.1371/journal.pone.0271493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Limited access to healthcare among children in sub-Saharan Africa (SSA) is a major cause of poor infant health indicators. Although many speculate that the private sector expansion has overwhelmingly reinforced health systems' utilization, little is known as to whether and where children are cared for when they are sick. This study investigated health-seeking behavior (HSB) among children from an urban area of Burkina Faso, with respect to disease severity and the type of provider versus children's characteristics. METHODS A cross-sectional population-based study was conducted in Ouagadougou, Burkina Faso using a two-stage sampling strategy. 1,098 households (2,411 children) data were collected. Generalized estimating equations (GEE) were used to analyze providers' choice for emergency, severe and non-severe conditions; sex-preference was further assessed with a χ2 test. RESULTS Thirty-six percent of children requiring emergency care sought private providers, as did 38% with severe conditions. Fifty-seven percent with non-severe conditions were self-medicated. A multivariable GEE indicated that University-educated household-heads would bring their children to for-profit (instead of public) providers for emergency (OR = 3.51, 95%CI = 1.90; 6.48), severe (OR = 4.05, 95%CI: 2.24; 7.30), and non-severe (OR = 3.25, 95%CI = 1.25; 8.42) conditions. A similar pattern was observed for insured and formal jobholders. Children's sex, age and gender was not associated with neither the type of provider preference nor the assessed health condition. CONCLUSION Private healthcare appeared to be crucial in the provision of care to children. The household head's socioeconomic status and insurance coverage significantly distinguished the choice of care provider. However, the phenomenon of son-preference was not found. These findings spotlighted children's HSB in Burkina Faso.
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Kosasih DM, Adam S, Uchida M, Yamazaki C, Koyama H, Hamazaki K. Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia. BMC Public Health 2022; 22:952. [PMID: 35549931 PMCID: PMC9102261 DOI: 10.1186/s12889-022-13142-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background The health insurance system in Indonesia was transformed in 2014 to achieve universal health coverage (UHC). The effective implementation of essential primary health services through UHC has resulted in efficient healthcare utilisation, which is reflected in the health-seeking behaviour of the community. Our study aimed to examine the changes in health-seeking behaviour before and after the implementation of UHC in Indonesia and to identify what factors determine these changes. Methods We conducted a retrospective cohort study using the recall method and data collected through questionnaire-based interviews in Bandung, Indonesia. We used a two-step sampling technique—randomised sampling and purposive sampling, and a total of 579 respondents with acute or chronic episodes were recruited. \documentclass[12pt]{minimal}
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\begin{document}$${\chi }^{2}$$\end{document}χ2 tests were used to identify the association between factors. Difference in difference model and a logistic regression model for binary outcomes were used to estimate the effect of the implementation of UHC on the health-seeking behaviour. Results Utilisation of public health facilities increased significantly after implementation of UHC, from 34.9% to 65.4% among the respondents with acute episodes and 33.7% to 65.8% among those with chronic episodes. The odds of respondents going to health facilities when they developed an acute episode increased after the implementation of UHC (OR = 1.22, p = 0.05; AOR = 1.42, p < 0.001). For respondents experiencing chronic episodes, the implementation of UHC increased the odds ratio (OR = 1.74, p < 0.001; AOR = 1.64, p < 0.001) that they would use health facilities. Five years after the implementation of UHC, we still found respondents who did not have health insurance (26 and 19 respondents among those with acute episode and chronic episode, respectively). Conclusions The effect of the implementation of UHC seemed greater for those experiencing chronic episodes than for those with an acute episode. Although the implementation of UHC has improved utilisation of public health facilities, the presence of people who are not covered by health insurance is a potential problem that could threaten future improvements in healthcare access and utilisation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13142-8.
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Affiliation(s)
- Dadan Mulyana Kosasih
- Department of Public Health, Graduate School of Medicine, Gunma University, Maebashi, Japan.,Health Office of Bandung City, Bandung, West Java, Indonesia
| | - Sony Adam
- Health Office of Bandung City, Bandung, West Java, Indonesia
| | - Mitsuo Uchida
- Department of Public Health, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Chiho Yamazaki
- Department of Public Health, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroshi Koyama
- Department of Public Health, Graduate School of Medicine, Gunma University, Maebashi, Japan.
| | - Kei Hamazaki
- Department of Public Health, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Kalolo A, Gautier L, De Allegri M. Exploring the Role of Social Representation in Micro-Health Insurance Scheme Enrolment and Retainment in Sub-Saharan Africa: A Scoping Review. Health Policy Plan 2022; 37:915-927. [DOI: 10.1093/heapol/czac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Low enrolment in micro-health insurance (MHI) schemes is a recurring issue affecting the viability of such schemes. Beyond the efforts addressing low subscription and retention in these schemes, little is known on how social representations are related to micro-health insurance schemes enrolment and retention. This scoping review aimed at exploring the role of social representations in shaping enrollment and retention in MHI in sub-Saharan Africa. We reviewed qualitative, quantitative and mixed methods studies conducted between 2004 and 2019 in sub-Saharan Africa. We limited our search to peer-reviewed and grey literature in English and French reporting on social representations of MHI. We defined social representations as conventions, cultural and religious beliefs, local rules and norms, local solidarity practices, political landscape and social cohesion. We applied the framework developed by Arksey and O’Malley and modified by Levac et al. to identify and extract data from relevant studies. We extracted information from a total of 78 studies written in English (60%) and in French (40%) of which 56% were conducted in West Africa. More than half of all studies explored either cultural and religious beliefs (56%) or social conventions (55%) whereas only 37% focused on social cohesion (37%). Only six papers (8%) touched upon all six categories of social representation considered in this study whereas 25% of the papers studied more than three categories. We found that all the studied social representations influence enrollment and retention in MHI schemes. Our findings highlight the paucity of evidence on social representations in relation to MHI schemes. This initial attempt to compile evidence on social representations invites more research on the role those social representations play on the viability of MHI schemes. Our findings call for program design and implementation strategies to consider and adjust to local social representations in order to enhance scheme attractiveness.
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Affiliation(s)
- Albino Kalolo
- Department of Public Health, St. Francis University College of Health and Allied Sciences, P.O. Box 175, Ifakara, Tanzania
| | - Lara Gautier
- Département de Gestion, d’Évaluation et de Politique de Santé, École de Santé Publique de l’Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, University of Heidelberg, Germany
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Al Mustanyir S, Turner B, Mulcahy M. The population of Saudi Arabia's willingness to pay for improved level of access to healthcare services: A contingent valuation study. Health Sci Rep 2022; 5:e577. [PMID: 35509406 PMCID: PMC9059215 DOI: 10.1002/hsr2.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 11/09/2022] Open
Abstract
Background and aims The Saudi Ministry of Health budget has surged since 2006 to put a strain on government finances at a time when the economy slowed as a result of plummeting oil prices. This study investigated the population of Saudi Arabia's willingness to pay for the healthcare services that are currently provided for free by the Saudi Ministry of Health, in return for improving their level of access. Methods Questionnaires were used to collect data from 600 individuals in the Riyadh region. The data were elicited using payment scale format and a two‐part model was employed for data analyses. Results The empirical analyses showed that the majority of the sample were willing to pay and found nine factors influenced people's willingness to pay—age, gender, education, employment status, nationality, marital status, current eligibility for healthcare services, possession of private health insurance, and having a chronic disease. Conclusion The results of this study suggest that policymakers in Saudi Arabia could reduce the burden on the Ministry of Health budget, while enabling people to improve their access to healthcare services. They might be of use to policymakers to help with fund allocation and priority setting.
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Affiliation(s)
- Salem Al Mustanyir
- Department of Accounting and Finance, Cork University Business School University College Cork Cork Ireland
| | - Brian Turner
- Department of Economics, Cork University Business School University College Cork Cork Ireland
| | - Mark Mulcahy
- Department of Accounting and Finance, Cork University Business School University College Cork Cork Ireland
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Akwaowo CD, Umoh I, Motilewa O, Akpan B, Umoh E, Frank E, Nna E, Okeke U, Onwujekwe OE. Willingness to Pay for a Contributory Social Health Insurance Scheme: A Survey of Rural Residents in Akwa Ibom State, Nigeria. Front Public Health 2021; 9:654362. [PMID: 34222168 PMCID: PMC8247944 DOI: 10.3389/fpubh.2021.654362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Health insurance is seen as a pathway to achieving Universal health coverage in low- and middle-income countries. The Nigeria Government has mandated states to set up social health insurance as a mechanism to offer financial protection to her citizens. However, the design of these schemes has been left to individual states. In preparation for the set-up of a contributory social health insurance scheme in Akwa Ibom State, Nigeria. This study assesses the willingness-to-pay for a social health insurance among rural residents in the state. Methods: The study was conducted in three local government areas in Akwa Ibom State, South south Nigeria. It was a cross-sectional study with multi-stage data collection using a demand questionnaire. Interviews were conducted with 286 household heads who were bread winners. Contingent valuation using iterative bidding with double bounded dichotomous technique was used to elicit the WTP for health insurance. Multiple regression using least square method was used to create a model for predicting WTP. Findings: About 82% of the household heads were willing to pay insurance premiums for their households. The median WTP for insurance premium was 11,142 Naira ($29), 95% CI: 9,599-12,684 Naira ($25-$33) per annum. The respondents were predominantly middle-aged (46.8%), Ibibio men (71.7%) with an average household size of five persons and bread winners who had secondary education (43.0%) and were mainly pentecostals (51.5%). The mean age of respondents was 46.4 ± 14.5 yrs. The two significant predictors of WTP for insurance premium amongst these rural residents were income of breadwinner (accounts for 79%) and size of household (2%). The regression coefficients for predicting WTP for insurance premium are intercept of 2,419, a slope of 0.1763 for Bread winner income and a slope of 741.5 household size, all values in Naira and kobo. Conclusion: Majority of rural residents in Akwa Ibom State were willing to pay for social health insurance. The amount they were willing to pay was significantly determined by the income of the breadwinner of the household and the size of the family. These findings are relevant to designing a contributory social health insurance scheme that is affordable and sustainable in order to ensure universal health coverage for the citizens.
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Affiliation(s)
| | - Idongesit Umoh
- Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | | | - Bassey Akpan
- Department of Community Medicine, University of Uyo, Uyo, Nigeria
| | - Edidiong Umoh
- Department of Geography and Natural Resources, University of Uyo, Uyo, Nigeria
| | - Edidiong Frank
- Obstetrics and Gynaecology, Immanuel Hospital, Eket, Nigeria
| | - Emmanuel Nna
- The Molecular Pathology Institute, Enugu, Nigeria
| | - Uchenna Okeke
- Department of Radiology, Nigerian Navy Reference Hospital, Calabar, Nigeria
| | - Obinna E. Onwujekwe
- Department of Pharmacology and Therapeutics, Institue of Health Policy and Research, University of Nigeria, Enugu, Nigeria
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Sana A, Rida F, Tayyaba I, Masooma M, Ayesha Z, Kalsoom A. Willingness to Pay for Community-Based Healthcare Insurance Schemes in Developing Countries: A Case of Lahore, Pakistan. Ethiop J Health Sci 2020; 30:135-142. [PMID: 32116442 PMCID: PMC7036450 DOI: 10.4314/ejhs.v30i1.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare costs and poverty are significant barriers to achieving universal access to healthcare. Thus, Community-Based Health Insurance Schemes (CBHIS) are regarded as an influential instrument for providing access to healthcare. For this purpose, this study was carried out in order to assess the community's Willingness to Pay (WTP) for CBHIS and its determinants among the residents of Lahore City. Methods A cross-sectional study was adopted during the period of May 2018 to August 2018 to conduct a standardized questionnaire survey among targeted population of Lahore. A total of 250 households from lower, middle and upper-middle-class areas were approached randomly from which 200 participated in the survey, rendering a response rate of 90.9%. Sample size was determined by using single population proportion formula assuming 5% margin of error and 95% Confidence Interval (CI). Moreover, multiple regression analysis, Pearson's correlation and t-test were employed to determine relationships between different variables affecting WTP. Results Sixty-four percent of the respondents were willing to pay for CBHIS. Among the remaining thirty-six% of unwilling the community, income level (p< 0.05, CI=0.34 to 1.11) and education level (p< 0.05, CI=0.52–1.37) were significant predictors of WTP. Moreover, strong positive relation (p<0.05) between people's awareness and WTP for CBHIS was witnessed. The findings further suggested that the larger population of the willing community was not willing to pay more than 5000 Rs annually. Conclusion Henceawareness level of the community regarding the benefits of CBHIS is a major hindrance. The key policy priority is to increase the community's awareness regarding the benefits of CBHIS and to increase willingness to pay rate among public.
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Affiliation(s)
- Akhtar Sana
- Department of Environmental Sciences, Kinnaird College for Women, 93-Jail Road, Lahore
| | - Fatima Rida
- Department of Environmental Sciences, Kinnaird College for Women, 93-Jail Road, Lahore
| | - Ishaq Tayyaba
- Department of Environmental Sciences, Kinnaird College for Women, 93-Jail Road, Lahore
| | - Mehmood Masooma
- Department of Environmental Sciences, Kinnaird College for Women, 93-Jail Road, Lahore
| | - Zulfqar Ayesha
- Department of Environmental Sciences, Kinnaird College for Women, 93-Jail Road, Lahore
| | - Akhtar Kalsoom
- Department of Statistics, Kinnaird College for Women, 93-Jail Road, Lahore
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Kado A, Merga BT, Adem HA, Dessie Y, Geda B. Willingness to Pay for Community-Based Health Insurance Scheme and Associated Factors Among Rural Communities in Gemmachis District, Eastern Ethiopia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:609-618. [PMID: 33122927 PMCID: PMC7591008 DOI: 10.2147/ceor.s266497] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background In sub-Saharan Africa, out-of-pocket expenditures constitute approximately 40% of total healthcare expenditures, imposing huge financial burdens on the poor. To tackle the effects of out-of-pocket payment for healthcare services, Ethiopia has been focusing on implementation and expansion of a community-based health insurance (CBHI) program since 2011. This study assessed willingness to pay for CBHI scheme and associated factors among rural communities in Gemmachis district, eastern Ethiopia. Methods Community-based cross-sectional study was conducted among 446 randomly selected participants in Gemmachis district from April 1 to April 30, 2019. Data were collected from participants using pretested structured questionnaires through face-to-face interview. Data were entered into EpiData version 3.1 and analyzed using SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with willingness to pay for CBHI. Results A total of 440 (98.7%) participants were involved in the study. Three in every four (74.8%) participants were willing to pay for CBHI (95% CI: 70.7%, 78.9%). Primary education (AOR=5.1, 95% CI: 2.4, 11.1), being merchant (AOR=0.23, 95% CI: 0.10, 0.51), housewife (AOR=3.8, 95% CI: 1.3, 11.0), poor (AOR=2.5, 95% CI: 1.3, 4.7), illness in the last one year (AOR=3.1, 95% CI, 1.9, 5.2), good knowledge about CBHI (AOR=2.3, 95% CI: 1.5, 3.6) and access to public health facility (AOR=2.0,95% CI: 1.1, 3.7) were all significantly associated with willingness to pay for CBHI. Conclusion A significant proportion of participants were willing to pay for CBHI scheme. Education, occupation, wealth status, illness in the last one year, knowledge about CBHI and access to healthcare facility were factors significantly associated with willingness to pay for CBHI. If the scheme is to serve as a means to provide access to health service, the premium for membership should be tailored and customized by individual socioeconomic factors.
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Affiliation(s)
- Abishu Kado
- West Hararghe Zonal Health Department, Chiro, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Colleges of Health and Medical Sciences, Arsi University, Asella, Ethiopia
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Hajek A, Enzenbach C, Stengler K, Glaesmer H, Hinz A, Röhr S, Stein J, Riedel-Heller SG, König HH. Determinants of Willingness to Pay for Health Insurance in Germany-Results of the Population-Based Health Study of the Leipzig Research Centre for Civilization Diseases (LIFE-Adult-Study). Front Public Health 2020; 8:456. [PMID: 32984246 PMCID: PMC7485392 DOI: 10.3389/fpubh.2020.00456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate which factors are associated with the willingness to pay (WTP) for health insurance. Methods: The analysis (n = 1,248 individuals) is based on data of a large population-based study—the Health Study of the Leipzig Research Centre for Civilization Diseases (LIFE-Adult-Study). With regard to WTP for health insurance, a contingent valuation method with a payment card was used. Several explanatory variables were included. For example, personality factors (in terms of agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience) were assessed using the NEO-16 Adjective Measure. Results: Average WTP for health insurance per month equaled about €240 which corresponds to ~14% of household net equivalent income. Multiple regressions showed that an increased WTP was associated with lower age (β = −1.7, p < 0.001), higher (log) household net equivalent income (β = 153.6, p < 0.001), higher social support (β = 2.0, p < 0.05), and private health insurance (β = 131.1, p < 0.001). Furthermore, an increased WTP for health insurance was associated with higher openness to experience (β = 10.1, p < 0.05), whereas it was not associated with agreeableness, conscientiousness, extraversion, and neuroticism. Conclusion: The quite large amount of average WTP for health insurance may suggest that individuals accept current contributions to health insurances and would probably accept higher contributions. While previous studies mainly focused on individuals in late life, we identified a link between socioeconomic, health-related factors, and personality factors (in terms of openness to experience) and WTP in the general adult population.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cornelia Enzenbach
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Katarina Stengler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Helios Park Hospital Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Sociology, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Sociology, University of Leipzig, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ogundeji YK, Akomolafe B, Ohiri K, Butawa NN. Factors influencing willingness and ability to pay for social health insurance in Nigeria. PLoS One 2019; 14:e0220558. [PMID: 31374083 PMCID: PMC6677309 DOI: 10.1371/journal.pone.0220558] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many low and middle-income countries are increasingly cognisant of the need to offer financial protection to its citizens through pre-payment schemes in order to curb high out of pocket expenditure and catastrophic spending on healthcare. However, there is limited rigorous contextual evidence to make decisions regarding optimal design of such schemes. This study assesses the willingness-to-pay (WTP) for the recently introduced state contributory health insurance scheme (SHIS) in Nigeria. METHODS The study took place in 6 local government areas in Kaduna state, North-west Nigeria. Data were collected from a household survey using a three-stage cluster sampling approach, with each household having the same probability of being selected. Interviews were conducted with 4000 individuals in 1020 households. Contingent valuation was used to elicit the willing to pay (WTP) for the household using the bidding game technique. The relationship between socioeconomic status and WTP was also examined using logistic regression models. FINDINGS About 82% of the household heads were willing to pay insurance premiums for their households, which came to an average of 513 Naira (1.68 USD) per month per person. The average amount individuals were willing to pay was lower in rural areas (611 Naira) compared to urban areas (463 Naira). These results were influenced by household size, level of education, occupation and household income. In addition, only 65% of the households had the ability to pay the average premium. CONCLUSION Socioeconomic factors influence individuals' WTP for contributory health insurance schemes. It is important to create awareness about the benefits of the insurance scheme, especially in rural areas, and in both the formal and informal sectors in Nigeria. WTP information can inform the amount of insurance premiums. However, it is important to consider differences between the WTP and the cost of benefits package to be offered, as the premium amount may need to be subsidized with public financing.
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Affiliation(s)
| | - Babatunde Akomolafe
- Department of Health Financing, Health Strategy & Delivery Foundation (HSDF), Abuja, Nigeria
| | - Kelechi Ohiri
- Department of Health Financing, Health Strategy & Delivery Foundation (HSDF), Abuja, Nigeria
| | - Nuhu Natie Butawa
- Department of Planning Research & Statistics, Ministry of Health, Kaduna, Nigeria
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Oga ASS, Attia-konan AR, Vehi F, Kouame J, Koffi K. Diabetic and cardiovascular patients' willingness to pay for upcoming national health insurance scheme in Côte d'Ivoire. HEALTH ECONOMICS REVIEW 2019; 9:8. [PMID: 30848393 PMCID: PMC6734508 DOI: 10.1186/s13561-019-0225-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Côte d'Ivoire's current health care financing system results from successive reforms undertaken with government funding and international support. The country is moving towards a national compulsory health insurance scheme. This context offered an opportunity to study additional features of health insurance's potential market in Sub-Sahara Africa developing economy. This study examined patients' willingness to pay in order to get access to health care when it is needed. METHODS A cross-sectional study was carried out in four tertiary level teaching hospitals from October to December 2017. These hospitals are located in Bouake (service of cardiology) and in Abidjan (two services of Endocrinology-Diabetology and Institute of Cardiology). Monthly willingness to pay was elicited using the contingent valuation method through a bidding game pre-tested interviewer-administered questionnaire. Multinomial logistic regression analysis was performed to predict participants' willingness to pay. RESULTS Out of 450 participants included in the analysis, 22.2% were not willing to pay at least 4.5 euros per month while 7.6%, 26.9%, 29.6%, 5.3% and 8.4% stated to be willing to pay 4.5, 7.5, 15, 30, and 45 euros per month, respectively. Males were 2.3 and 2.5 times more likely to be willing to pay 4.5 or 7.5 and 30 or 45 euros, respectively. However, there was no statistically significant difference between males and females who stated being willing to pay a premium of 15 euros per month as compared to the participants in the reference modality, below 4.5 euros. CONCLUSIONS The findings indicated that the amount that participants were willing to pay is consistent with other previously elicited. The association of sex with the willingness to pay suggested what might influence the acceptability of and the contribution to the upcoming compulsory health insurance scheme. These pointed out that some market features have to be understood for a successful implementation of this social health insurance scheme.
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Affiliation(s)
- Agbaya Stéphane Serge Oga
- Département de Santé Publique, Hydrologie et Toxicologie, UFR Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Service Information Médicale, Institut de Cardiologie d’Abidjan, Abidjan, Côte d’Ivoire
| | - Akissi Régine Attia-konan
- Département de Santé Publique, Hydrologie et Toxicologie, UFR Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Centre de Recherche et d’Etudes en Populations Politiques et Systèmes de Santé, Institut National de Santé Publique, Abidjan, Côte d’Ivoire
| | - Fulgence Vehi
- Département de Santé Publique, Hydrologie et Toxicologie, UFR Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Jérôme Kouame
- Département de Santé Publique, Hydrologie et Toxicologie, UFR Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Centre de Recherche et d’Etudes en Populations Politiques et Systèmes de Santé, Institut National de Santé Publique, Abidjan, Côte d’Ivoire
| | - Kouamé Koffi
- Département de Santé Publique, Hydrologie et Toxicologie, UFR Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Service de Pharmacie, CHU Cocody, Abidjan, Côte d’Ivoire
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Minyihun A, Gebregziabher MG, Gelaw YA. Willingness to pay for community-based health insurance and associated factors among rural households of Bugna District, Northeast Ethiopia. BMC Res Notes 2019; 12:55. [PMID: 30678716 PMCID: PMC6346545 DOI: 10.1186/s13104-019-4091-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Community based health insurance schemes are becoming recognized as powerful method to achieve universal health coverage and reducing the financial catastrophic shock of the community. Therefore, this study aimed to assess willingness to pay for community-based health insurance and associated factors among rural households of Bugna District, Ethiopia. RESULTS A total of 532 study participants were included in the study. The finding indicated that 77.8% of the households were willing to pay for the community-based health insurance. The average amount of money the households were willing to pay per household per annum was 233 ETB ($11.12 USD). The result of the study also revealed that attending formal education[ß = 3.20; 95% CI = 1.87, 4.53], history of illness [ß = 2.52; 95% CI = 1.29, 3.75], household size [ß = 0.408; 95% CI = 0.092, 0.724], awareness about the scheme [ß = 2.96; 95% CI = 1.61, 4.30], and wealth status [ß = 5.55; 95% CI = 4.19, 6.90] were factors significantly associated with willingness to pay. Therefore, enhancing awareness of the community about the scheme, considering the amount of premium as per household family size and wealth status might increase household's willingness to pay for community-based health insurance.
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Affiliation(s)
- Amare Minyihun
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.o. Box: 196, Gondar, Ethiopia
| | | | - Yalemzewd Assefa Gelaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sociodemographic patterns of health insurance coverage in Namibia. Int J Equity Health 2019; 18:16. [PMID: 30670031 PMCID: PMC6341740 DOI: 10.1186/s12939-019-0915-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/06/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Health insurance has been found to increase healthcare utilisation and reduce catastrophic health expenditures in a number of countries; however, coverage is often unequally distributed among populations. The sociodemographic patterns of health insurance in Namibia are not fully understood. We aimed to assess the prevalence of health insurance, the relation between health insurance and health service utilisation and to explore the sociodemographic factors associated with health insurance in Namibia. Such findings may help to inform health policy to improve financial access to healthcare in the country. METHODS Using data on 14,443 individuals, aged 15 to 64 years, from the 2013 Namibia Demographic and Health Survey, the association between health insurance and health service utilisation was investigated using multivariable mixed effects Poisson regression analyses, adjusted for sociodemographic covariates and regional, enumeration area and household clustering. Multivariable mixed effects Poisson regression analyses were also conducted to explore the association between key sociodemographic factors and health insurance, adjusted for covariates and clustering. Effect modification by sex, education level and wealth quintile was also explored. RESULTS Just 17.5% of this population were insured (men: 20.2%; women: 16.2%). In fully-adjusted analyses, education was significantly positively associated with health insurance, independent of other sociodemographic factors (higher education RR: 3.98; 95% CI: 3.11-5.10; p < 0.001). Female sex (RR: 0.83; 95% CI: 0.74-0.94; p = 0.003) and wealth (highest wealth quintile RR: 13.47; 95% CI: 9.06-20.04; p < 0.001) were also independently associated with insurance. There was a complex interaction between sex, education and wealth in the context of health insurance. With increasing education level, women were more likely to be insured (p for interaction < 0.001), and education had a greater impact on the likelihood of health insurance in lower wealth quintiles. CONCLUSIONS In this population, health insurance was associated with health service utilisation but insurance coverage was low, and was independently associated with sex, education and wealth. Education may play a key role in health insurance coverage, especially for women and the less wealthy. These findings may help to inform the targeting of strategies to improve financial protection from healthcare-associated costs in Namibia.
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Yang F, Gannon B, Weightman A. Public's Willingness to Pay Towards a Medical Device for Detecting Foot Ulceration in People with Diabetes. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:559-567. [PMID: 29948927 DOI: 10.1007/s40258-018-0400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Diabetic foot ulceration (DFU) is a common and serious complication among diabetic patients. A medical device has been developed to prevent the occurrence of DFU. The aim of this study was to investigate the willingness to pay (WTP) for this device among the general public in the UK. METHODS A contingent valuation survey was administered to 1051 participants through an online survey including questions on socio-demographic characteristics, self-reported health, knowledge of diabetes and medical devices, and WTP. A two-part model was used to analyse determinants of WTP, including a logistic model in the first part and a generalised linear model with a log-transformed WTP in the second part. RESULTS More than half (55.9%) of the participants expressed a positive WTP. The annual mean (standard deviation) and median (interquartile range) WTP values were £76.9 (69.1) and £50 (80), respectively. Older age, middle-level education, good/excellent self-reported health, visiting doctors once/2-5 times, diabetes experience, medical device experience and more than average self-perceived likelihood of using similar devices were associated with a higher likelihood of willingness to pay. Younger age, male gender and higher household income were associated with higher WTP values. CONCLUSION This study demonstrated that people are willing to pay for this device and they tend to contribute when they have experience of diabetes or similar devices and perceive self-benefit.
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Affiliation(s)
- Fan Yang
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
| | - Brenda Gannon
- Centre for Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Weightman
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
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Wang Q, Zhou Y, Ding X, Ying X. Demand for Long-Term Care Insurance in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 15:ijerph15010006. [PMID: 29271906 PMCID: PMC5800106 DOI: 10.3390/ijerph15010006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/02/2017] [Accepted: 12/16/2017] [Indexed: 01/31/2023]
Abstract
The aim of this study was to estimate willingness to pay (WTP) for long-term care insurance (LTCI) and to explore the determinants of demand for LTCI in China. We collected data from a household survey conducted in Qinghai and Zhejiang on a sample of 1842 households. We relied on contingent valuation methods to elicit the demand for LTCI and random effects logistic regression to analyze the factors associated with the demand for LTCI. Complementarily, we used document analysis to compare the LTCI designed in this study and the current LTCI policies in the pilot cities. More than 90% of the respondents expressed their willingness to buy LTCI. The median WTP for LTCI was estimated at 370.14 RMB/year, accounting for 2.29% of average annual per capita disposable income. Price, age, education status, and income were significantly associated with demand for LTCI. Most pilot cities were found to mainly rely on Urban Employees Basic Medical Insurance funds as the financing source for LTCI. Considering that financing is one of the greatest challenges in the development of China's LTCI, we suggest that policy makers consider individual contribution as an important and possible option as a source of financing for LTCI.
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Affiliation(s)
- Qun Wang
- Faculty of Humanities and Social Sciences, Dalian University of Technology, Dalian 116024, China.
| | - Yi Zhou
- School of Public Health, Fudan University, Shanghai 200032, China.
| | - Xinrui Ding
- Faculty of Humanities and Social Sciences, Dalian University of Technology, Dalian 116024, China.
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai 200032, China.
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Umeh CA, Feeley FG. Inequitable Access to Health Care by the Poor in Community-Based Health Insurance Programs: A Review of Studies From Low- and Middle-Income Countries. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:299-314. [PMID: 28655804 PMCID: PMC5487091 DOI: 10.9745/ghsp-d-16-00286] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
The poor lack equitable access to health care in community-based health insurance schemes. Flexible installment payment plans, subsidized premiums, and elimination of co-pays can increase enrollment and use of health services by the poor. Background: Out-of-pocket payments for health care services lead to decreased use of health services and catastrophic health expenditures. To reduce out-of-pocket payments and improve access to health care services, some countries have introduced community-based health insurance (CBHI) schemes, especially for those in rural communities or who work in the informal sector. However, there has been little focus on equity in access to health care services in CBHI schemes. Methods: We searched PubMed, Web of Science, African Journals OnLine, and Africa-Wide Information for studies published in English between 2000 and August 2014 that examined the effect of socioeconomic status on willingness to join and pay for CBHI, actual enrollment, use of health care services, and drop-out from CBHI. Our search yielded 755 articles. After excluding duplicates and articles that did not meet our inclusion criteria (conducted in low- and middle-income countries and involved analysis based on socioeconomic status), 49 articles remained that were included in this review. Data were extracted by one author, and the second author reviewed the extracted data. Disagreements were mutually resolved between the 2 authors. The findings of the studies were analyzed to identify their similarities and differences and to identify any methodological differences that could account for contradictory findings. Results: Generally, the rich were more willing to pay for CBHI than the poor and actual enrollment in CBHI was directly associated with socioeconomic status. Enrollment in CBHI was price-elastic—as premiums decreased, enrollment increased. There were mixed results on the effect of socioeconomic status on use of health care services among those enrolled in CBHI. We found a high drop-out rate from CBHI schemes that was not related to socioeconomic status, although the most common reason for dropping out of CBHI was lack of money to pay the premium. Conclusion: The effectiveness of CBHI schemes in achieving universal health coverage in low- and middle-income countries is questionable. A flexible payment plan where the poor can pay in installments, subsidized premiums for the poor, and removal of co-pays are measures that can increase enrollment and use of CBHI by the poor.
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Affiliation(s)
- Chukwuemeka A Umeh
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Frank G Feeley
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Nguyen LH, Hoang ATD. Willingness to Pay for Social Health Insurance in Central Vietnam. Front Public Health 2017; 5:89. [PMID: 28487850 PMCID: PMC5403811 DOI: 10.3389/fpubh.2017.00089] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 04/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background A social health insurance (SHI) program was implemented in Vietnam in 1992. Participation is compulsory for some groups, such as formal-sector workers and voluntary for other groups. In 2013, 68% of the total population was covered by SHI, with most enrollees from compulsory groups. Enrollment has remained low among persons whose enrollment is voluntary. As a result, households face financial risk due to high out-of-pocket payments for health care. The goal of this study is to identify willingness to pay (WTP) for the SHI scheme among persons whose enrollment is voluntary and to examine factors that influence their choice. Method Three hundred thirty-one uninsured persons from three districts and one city of Thua Thien Hue province were interviewed face to face using a structured questionnaire. Contingent valuation technique was used to assess the WTP among the study participants. Each individual was asked to choose the maximum premium they were willing to pay for a health insurance card per year with three copayment levels of 0, 10, and 20%. Seven premium levels were offered ranging from 0 to 900,000 Vietnamese Dong (VND) (42.12 USD). The mean WTP of respondents for each scenario was estimated. Multiple linear regression analysis was used to identify factors influencing WTP for SHI. Results The survey found that 73.1, 72.2, and 71.6%, respectively, for each copayment level, of the respondents would agree to participate in the SHI scheme and are willing to pay an annual premium of 578,926 VND (27.1 USD); 473,222 VND (22.1 USD); and 401,266 VND (18.8 USD) at the copayment levels of 0, 10, and 20%, respectively. The WTP for SHI is influenced by knowledge of SHI at all copayment levels (p value < 0.05). The more knowledge about SHI individuals have, the higher the WTP amount. Chronic disease was related to WTP only at a copayment level of 20% (p = 0.049). Conclusion Enhanced awareness of the benefits of SHI among the population should contribute to expanding SHI coverage in Vietnam.
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Affiliation(s)
- Lan Hoang Nguyen
- Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Anh Thuan Duc Hoang
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Awoonor-Williams JK, Tindana P, Dalinjong PA, Nartey H, Akazili J. Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:23. [PMID: 27595842 PMCID: PMC5011972 DOI: 10.1186/s12914-016-0095-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/25/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC. METHODS Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC. RESULTS The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC. CONCLUSION This study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC.
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Affiliation(s)
- John Koku Awoonor-Williams
- Regional Health Directorate, Ghana Health Service PMB, Upper East Region, Bolgatanga, Ghana
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- University of Basel, Peterplatz 4003, Basel, Switzerland
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, P.O.Box 114, Navrongo, Ghana
| | | | - Harry Nartey
- Regional Health Directorate, Ghana Health Service PMB, Upper East Region, Bolgatanga, Ghana
| | - James Akazili
- Navrongo Health Research Centre, Ghana Health Service, P.O.Box 114, Navrongo, Ghana
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Awoonor-Williams JK, Tindana P, Dalinjong PA, Nartey H, Akazili J. Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:21. [PMID: 27576456 PMCID: PMC5006541 DOI: 10.1186/s12914-016-0096-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/25/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC. METHODS Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from participants for the achievement of the goals of UHC and PHC. RESULTS The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS, inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC. CONCLUSION This study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC.
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Affiliation(s)
- John Koku Awoonor-Williams
- Regional Health Directorate, Ghana Health Service PMB, Upper East Region, Bolgatanga, Ghana
- Regional Health Directorate, Ghana Health Service, PMB, Bolgatanga, Upper East Region Ghana
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, P. O. Box 114, Navrongo, Ghana
| | | | - Harry Nartey
- Regional Health Directorate, Ghana Health Service PMB, Upper East Region, Bolgatanga, Ghana
| | - James Akazili
- Navrongo Health Research Centre, Ghana Health Service, P. O. Box 114, Navrongo, Ghana
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Mbogo BA, McGill D. "Perspectives on financing population-based health care towards Universal Health Coverage among employed individuals in Ghanzi district, Botswana: A qualitative study". BMC Health Serv Res 2016; 16:413. [PMID: 27543136 PMCID: PMC4992196 DOI: 10.1186/s12913-016-1657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, about 150 million people experience catastrophic healthcare expenditure services annually. Among low and middle income countries, out-of-pocket expenditure pushes about 100 million people into poverty annually. In Botswana, 83 % of the general population and 58 % of employed individuals do not have medical aid coverage. Moreover, inequity allocation of financial resources between health services suggests marginalization of population-based health care services (i.e. diseases prevention and health promotion). The purpose of the study is to explore perspectives on employed individuals regarding financing population based health care interventions towards Universal Health Coverage (UHC) in order to make recommendations to the Ministry of Health on health financing options to cover population-based health services. METHODS A qualitative design grounded in interpretivist epistemology through social constructivism lens was critical for exploring perspectives of employed individuals. Through purposive and snowballing sampling techniques, a total of 15 respondents including 8 males and 7 females were recruited and interviewed using a semi-structured format. Their age ranged from 23 to 59 years with a median of 36 years. Data was analyzed using Thematic Content Analysis technique. RESULTS Use of social constructivism lens enabled to classify emerging themes into population coverage, health services coverage and financial protection issues. Despite broad understanding of health coverage schemes among participants, knowledge appears insignificant in increasing enrolment. Participants indicated limited understanding of UHC concepts, however showed willingness to embrace UHC upon brief description. Main thematic issues raised include: exclusion of population-based health services from coverage scheme; disparity in financial protection and health services coverage among enrollees; inability to sustain contracted employees; and systematic exclusion of unemployed individuals and informal sector employees. CONCLUSION Increasing enrolment in health coverage schemes requires targeted campaign for information dissemination through use of myriads mass media including: social networks, TV, Radio and others. Moreover, re-designing health insurance schemes is critical in order to include population-based interventions; expand uptake of unemployed and informal sector employees; flexibility in monthly premiums payment plan and use of technology to increase access to payment points. Further study need to evaluate the content of health financing policy in Botswana measured against the World Health Organization Universal Health Coverage conceptual requirements for Low and Middle Income Countries.
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Affiliation(s)
| | - Deborah McGill
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL UK
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Udeh EI, Onwujekwe OE, Adewole DA, Onoka CA. Exploring the threshold premium for viable community based health insurance schemes in Nigeria. BMC Res Notes 2016; 9:383. [PMID: 27485606 PMCID: PMC4971742 DOI: 10.1186/s13104-016-2185-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/26/2016] [Indexed: 11/24/2022] Open
Abstract
Background The national health insurance scheme of Nigeria recently proposed a national premium for community based insurance scheme. This study determined the capacity of households in the rural and urban areas in Nigeria to pay for the premium and different hypothetical health insurance schemes namely national health insurance scheme, national urban health insurance scheme, national rural health insurance scheme and regional health insurance schemes. It determined the likely impact of different premiums on membership across socio-economic status quintiles, and then determined the threshold premium affordable to rural and urban households. Results The results show that the mean capacity to pay for the households in different regions ranged from US$194 ± 100 to US$986 ± 907. The threshold premiums of the national health insurance scheme, urban national health insurance and rural health insurance schemes were US$66, US$154 and US$53 respectively. Conclusions Overall, the threshold premium for rural national health insurance scheme and national health insurance schemes were affordable to the lowest socio economic group. Hence, it is recommended that threshold premium for rural national health insurance scheme be adopted as the maximum premium not to be exceeded in the proposed national health insurance scheme.
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Affiliation(s)
- Emeka Ihechi Udeh
- Department of Surgery, Faculty of Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria.
| | - Obinna Emmanuel Onwujekwe
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Nigeria.,Department of Pharmacology and Therapeutics, Faculty of Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | | | - Chima Ariel Onoka
- Department of Community Medicine, Faculty of Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
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Nosratnejad S, Rashidian A, Dror DM. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries. PLoS One 2016; 11:e0157470. [PMID: 27362356 PMCID: PMC4928775 DOI: 10.1371/journal.pone.0157470] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/30/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature. METHODS We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP. RESULT 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP. CONCLUSIONS The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.
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Affiliation(s)
- Shirin Nosratnejad
- Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Tabriz Health Services Management Research Center, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - David Mark Dror
- Micro Insurance Academy, New Delhi, India
- Former hon. Professor, Erasmus University Rotterdam, Rotterdam, Netherland
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Bock JO, Hajek A, Brenner H, Saum KU, Matschinger H, Haefeli WE, Schöttker B, Quinzler R, Heider D, König HH. A Longitudinal Investigation of Willingness to Pay for Health Insurance in Germany. Health Serv Res 2016; 52:1099-1117. [PMID: 27324300 DOI: 10.1111/1475-6773.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate factors affecting willingness to pay (WTP) for health insurance of older adults in a longitudinal setting in Germany. DATA SOURCES Survey data from a cohort study in Saarland, Germany, from 2008-2010 and 2011-2014 (n1 = 3,124; n2 = 2,761) were used. STUDY DESIGN Panel data were taken at two points from an observational, prospective cohort study. DATA COLLECTION WTP estimates were derived using a contingent valuation method with a payment card. Participants provided data on sociodemographics, lifestyle factors, morbidity, and health care utilization. PRINCIPAL FINDINGS Fixed effects regression models showed higher individual health care costs to increase WTP, which in particular could be found for members of private health insurance. Changes in income and morbidity did not affect WTP among members of social health insurance, whereas these predictors affected WTP among members of private health insurance. CONCLUSIONS The fact that individual health care costs affected WTP positively might indicate that demanding (expensive) health care services raises the awareness of the benefits of health insurance. Thus, measures to increase WTP in old age should target at improving transparency of the value of health insurances at the moment when individual health care utilization and corresponding costs are still relatively low.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nosratnejad S, Rashidian A, Mehrara M, Jafari N, Moeeni M, Babamohamadi H. Factors Influencing Basic and Complementary Health Insurance Purchasing Decisions in Iran: Analysis of Data From a National Survey. WORLD MEDICAL & HEALTH POLICY 2016. [DOI: 10.1002/wmh3.187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bock JO, Heider D, Matschinger H, Brenner H, Saum KU, Haefeli WE, König HH. Willingness to pay for health insurance among the elderly population in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:149-158. [PMID: 25526928 DOI: 10.1007/s10198-014-0663-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/27/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans. METHODS Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57-84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals' WTP was elicited based on a contingent valuation method with a payment card. RESULTS Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20% of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly. DISCUSSION The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straβe 55, 04103, Leipzig, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Ahmed S, Hoque ME, Sarker AR, Sultana M, Islam Z, Gazi R, Khan JAM. Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh. PLoS One 2016; 11:e0148211. [PMID: 26828935 PMCID: PMC4734618 DOI: 10.1371/journal.pone.0148211] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 01/14/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Reliance on out-of-pocket payment for healthcare may lead poor households to undertake catastrophic health expenditure, and risk-pooling mechanisms have been recommended to mitigate such burdens for households in Bangladesh. About 88% of the population of Bangladesh depends on work in the informal sector. We aimed to estimate willingness-to-pay (WTP) for CBHI and identify its determinants among three categories of urban informal workers rickshaw-pullers, shopkeepers and restaurant workers. METHODS The bidding game version of contingent valuation method was used to estimate weekly WTP. In three urban locations 557 workers were interviewed using a structured questionnaire during 2010 and 2011. Multiple-regression analysis was used to predict WTP by demographic and household characteristics, occupation, education level and past illness. RESULTS WTP for a CBHI scheme was expressed by 86.7% of informal workers. Weekly average WTP was 22.8 BDT [Bangladeshi Taka; 95% confidence interval (CI) 20.9-24.8] or 0.32 USD and varied significantly across occupational groups (p = 0.000) and locations (p = 0.003). WTP was highest among rickshaw-pullers (28.2 BDT or 0.40 USD; 95% CI: 24.7-31.7), followed by restaurant workers (20.4 BDT 0.29 USD; 95% CI: 17.0-23.8) and shopkeepers (19.2 BDT or 0.27 USD; 95% CI: 16.1-22.4). Multiple regression analysis identified monthly income, occupation, geographical location and educational level as the key determinants of WTP. WTP increased 0.196% with each 1% increase in monthly income, and was 26.9% lower among workers with up to a primary level of education versus those with higher than primary, but less than one year of education. CONCLUSION Informal workers in urban areas thus are willing to pay for CBHI and socioeconomic differences explain the magnitude of WTP. The policy maker might think introducing community-based model including public-community partnership model for healthcare financing of informal workers. Decision making regarding the implementation of such schemes should consider worker location and occupation.
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Affiliation(s)
- Sayem Ahmed
- Health Economics & Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | | | - Abdur Razzaque Sarker
- Health Economics & Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Marufa Sultana
- Health Economics & Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ziaul Islam
- Health Economics & Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rukhsana Gazi
- Health Economics & Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jahangir A. M. Khan
- Health Economics & Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- James P Grant School of Public health, BRAC University and International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Wandei S, Nangami M, Egesa O. Ability and willingness to pay for voluntary medical male circumcision: a cross-sectional survey in Kisumu County, Kenya. AIDS Care 2015; 28:471-4. [PMID: 26654584 DOI: 10.1080/09540121.2015.1114998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Voluntary medical male circumcision is one of the most effective measures in preventing male acquisition of HIV during heterosexual intercourse. In Kenya, the voluntary medical male circumcision programme was launched in the year 2008 as part of a comprehensive national HIV prevention strategy. With the global challenge of funding HIV intervention programs, the sustainability of the programme beyond the donor periods need to be assessed. The purpose of this study was to determine the household ability and willingness to pay for voluntary medical male circumcision as an alternative method of funding the programme. The findings show that 62.2% of the households were "able" to pay for medical circumcision. However, 60.4% of them were not "willing" to pay for the service regardless of the cost. The findings indicate that ability to pay is not a significant predictor of willingness to pay for voluntary medical male circumcision within Kisumu County. Knowledge on the role of medical circumcision is a more important factor in determining willingness to pay for the service.
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Affiliation(s)
- Stephen Wandei
- a Department of Health Management and Policy, School of Public Health , Moi University , Eldoret , Kenya
| | - Mabel Nangami
- a Department of Health Management and Policy, School of Public Health , Moi University , Eldoret , Kenya
| | - Omar Egesa
- b Department of Anthropology and Human Ecology, School of Arts and Social Sciences , Moi University , Eldoret , Kenya
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Adebayo EF, Uthman OA, Wiysonge CS, Stern EA, Lamont KT, Ataguba JE. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries. BMC Health Serv Res 2015; 15:543. [PMID: 26645355 PMCID: PMC4673712 DOI: 10.1186/s12913-015-1179-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 11/18/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs. METHODS We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review. RESULTS Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment. CONCLUSION In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers' access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.
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Affiliation(s)
- Esther F Adebayo
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- School of Public Health and Family Medicine, University of Cape Town, Observatory, South Africa.
| | - Olalekan A Uthman
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The university of Warwick, Coventry, CV4 7AL, UK.
- Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK.
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Erin A Stern
- Women's Health Research Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Kim T Lamont
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - John E Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, South Africa.
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Agago TA, Woldie M, Ololo S. Willingness to join and pay for the newly proposed social health insurance among teachers in Wolaita Sodo Town, South Ethiopia. Ethiop J Health Sci 2015; 24:195-202. [PMID: 25183925 PMCID: PMC4141222 DOI: 10.4314/ejhs.v24i3.2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Cost-sharing between beneficiaries and governments is critical to achieve universal health care coverage. To address this, Ethiopia is currently introducing Social Health Insurance. However, there has been limited evidence on willingness to join the newly proposed insurance scheme in the country. The purpose of this study is to assess willingness to join and pay for the scheme among teachers in Wolaita Sodo Town government educational institutions, South Ethiopia. Methods A cross-sectional study was conducted from February 5 to March 10, 2012 on 335 teachers. Stratified simple random sampling technique was used and data were collected using structured interviewer administered questionnaire. Binary and multiple logistic regressions were used to estimate the crude and adjusted odds ratios for willingness to pay. Results Three hundred twenty-eight teachers participated in the study with response rate of 98%. About 55% of the teachers had never heard of any type of health insurance scheme. However, 74.4% of them were willing to pay for the suggested insurance scheme. About 47% of those who were willing to pay agreed to contribute greater than or equal to 4% of their monthly salaries. Willingness to pay was more likely among those who had heard about health insurance, had previous history of inability to pay for medical bills and achieved higher educational status. Conclusion The majority of the teachers were willing to join social health insurance; however, adequate awareness creation and discussion should be made with all employees at various levels for the successful implementation of the scheme.
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Affiliation(s)
| | - Mirkuzie Woldie
- Department of Health Services Management, Jimma University, Ethiopia
| | - Shimeles Ololo
- Department of Health Services Management, Jimma University, Ethiopia
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Adams R, Chou YJ, Pu C. Willingness to participate and Pay for a proposed national health insurance in St. Vincent and the grenadines: a cross-sectional contingent valuation approach. BMC Health Serv Res 2015; 15:148. [PMID: 25890181 PMCID: PMC4404596 DOI: 10.1186/s12913-015-0806-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous Caribbean countries are considering implementing National Health Insurance (NHI) and pooling resources to finance their health sectors. Based on this increased interest in health insurance, we investigated the willingness to participate and to pay for NHI in St. Vincent and the Grenadines, an upper-middle-income Caribbean country. METHODS Four hundred heads of household in St. Vincent and the Grenadines were interviewed in August 2012 and September 2012. The samples were selected through simple random sampling, including the stratification of rural, semiurban, and urban communities to ensure the representativeness of the sample. A contingent valuation method with a pretested interviewer-led questionnaire was used. Respondents were presented with a hypothetical NHI plan. Chi-squared analysis was performed to identify factors that are associated with the willingness to participate. Multiple logistic regression was used to explore the factors that influence respondents' willingness to pay. RESULTS In total, 69.5% (n = 278) of the respondents indicated that they were willing to participate in the proposed NHI plan, of whom 72.3% were willing to pay for the first bid (EC$50). When the bid was reduced to EC$25, all of the remaining respondents who indicated they were willing to participate were willing to pay this lowered bid. Overall, the respondents were willing to pay EC$77.83 (US$28.83) per month for each person to enroll in the NHI plan. Age, income, and having some form of health insurance were significantly associated with a willingness to participate in the plan. CONCLUSIONS A higher socioeconomic status was the principal determinant factor for the willingness to participate. This is similar to studies on developing economies. The government can use these findings to guide the successful implementation of the proposed NHI program. People with a lower socioeconomic status must be engaged from the start of and throughout the development process to enhance their understanding of and participation in the plan.
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Affiliation(s)
- Rosmond Adams
- Ministry of Health, Wellness and Environment, Ministerial Building, Halifax Street, Kingstown, St. Vincent and the Grenadines.
| | - Yiing-Jenq Chou
- Department of Public Health, National Yang Ming University, 155, Sec.2, Linong Street, Taipei, 112, Taiwan.
| | - Christy Pu
- Department of Public Health, National Yang Ming University, 155, Sec.2, Linong Street, Taipei, 112, Taiwan.
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Shariful Islam SM, Lechner A, Ferrari U, Seissler J, Holle R, Niessen LW. Mobile phone use and willingness to pay for SMS for diabetes in Bangladesh. J Public Health (Oxf) 2015; 38:163-9. [PMID: 25687131 DOI: 10.1093/pubmed/fdv009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mobile phone SMS is increasingly used as a means of communication between patients and their healthcare providers in many countries of the world. We investigated mobile phone use and factors associated with willingness-to-pay (WTP) for diabetes SMS among patients with type 2 diabetes in Bangladesh. METHODS As part of a randomized controlled study, in 515 patients with type 2 diabetes, socioeconomic status, mobile phone use, WTP for diabetes SMS, anthropometry and HbA1c were measured. Multivariate regression was used to identify factors associated with WTP. RESULTS The median (interquartile range [IQR]) of WTP for diabetes SMS was 20 (45) Bangladesh Taka (BDT) (1 BDT = 0.013 US$). WTP was significantly higher for males [OR 2.4, 95% CI (1.0-5.7)], patients with household income >50 000 BDT [4.6 (1.1-20.4)] and those with primary education [5.6 (1.2-26.6)] and secondary and higher education [5.2 (1.4-19.6)]. CONCLUSIONS The high proportion of mobile phone use and WTP for diabetes SMS are encouraging as possible strategy to use such technologies and deserve further evaluation.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Center for Control of Chronic Diseases (CCCD), International Center for Diarrhoeal Disease Research, Bangladesh (Icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Leopoldstraße 7, München 80802, Germany
| | - Andreas Lechner
- Diabetes Center, Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, München 80336, Germany
| | - Uta Ferrari
- Diabetes Center, Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, München 80336, Germany
| | - Jochen Seissler
- Diabetes Center, Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, München 80336, Germany
| | - Rolf Holle
- Economic Evaluations, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Munich, Germany
| | - Louis W Niessen
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Osungbade KO, Ayinde OO. Maternal complication prevention: evidence from a case-control study in southwest Nigeria. Afr J Prim Health Care Fam Med 2014; 6:E1-7. [PMID: 26245427 PMCID: PMC4565040 DOI: 10.4102/phcfm.v6i1.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/08/2014] [Accepted: 05/01/2014] [Indexed: 11/28/2022] Open
Abstract
Background The importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes. Aim This study investigated differences in risk factors for maternal complications in booked and unbooked pregnant women in Nigeria, and provided evidence for their prevention. Setting The study was carried out in a postnatal ward in a secondary health facility. Methods This was a case-control study involving booked and unbooked pregnant women who had delivered. Consecutive enrolment of all unbooked pregnant women (cases) was done, and one booked pregnant woman (control) was enrolled and matched for age with each of these. Both groups were interviewed using a questionnaire, whilst records of delivery were extracted from the hospital files. Findings were subjected to logistical regression at a significance level of p < 0.05. Results Booked women had a lower median length of labour (10 hours) compared to unbooked women (13 hours). More women in the booked control group (139; 35.1%) than in the unbooked case group (96; 23.6%) reported at least one type of morbidity during the index pregnancy (p = 0.0004). Booking status was associated with a likelihood of spontaneous vaginal delivery. Young maternal age, low education, rural residence and low socio-economic status were associated with less likelihood of using prenatal services. Young maternal age, low education and intervention in the delivery were associated with a likelihood of experiencing a complication of delivery. Conclusion Strengthening antenatal and secondary healthcare services as short- and medium-term measures might be cost-effective as a preventive strategy in complications of pregnancy, whilst socio-economic dimensions of health are accorded priority in the long term.
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Affiliation(s)
- Kayode O Osungbade
- Faculty of Public Health, College of Medicine, University of Ibadan and University College Hospital, Ibadan.
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Macha J, Kuwawenaruwa A, Makawia S, Mtei G, Borghi J. Determinants of community health fund membership in Tanzania: a mixed methods analysis. BMC Health Serv Res 2014; 14:538. [PMID: 25411021 PMCID: PMC4246628 DOI: 10.1186/s12913-014-0538-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022] Open
Abstract
Background In many developing countries, initiatives are underway to strengthen voluntary community based health insurance as a means of expanding access to affordable care among the informal sector. However, increasing coverage with voluntary health insurance in low income settings can prove challenging. There are limited studies on determinants of enrolling in these schemes using mixed methods. This study aims to shed light on the characteristics of those joining a community health fund, a type of community based health insurance, in Tanzania and the reasons for their membership and subsequent drop out using mixed methods. Methods A cross sectional survey of households in four rural districts was conducted in 2008, covering a total of 1,225 (524 members of CHF and 701 non-insured) households and 7,959 individuals. In addition, 12 focus group discussions were carried out with CHF members, non-scheme members and members of health facility governing committees in two rural districts. Logistic regression was used to assess the determinants of CHF membership while thematic analysis was done to analyse qualitative data. Results The quantitative analysis revealed that the three middle income quintiles were more likely to enrol in the CHF than the poorest and the richest. CHF member households were more likely to be large, and headed by a male than uninsured households from the same areas. The qualitative data supported the finding that the poor rather than the poorest were more likely to join as were large families and of greater risk of illness, with disabilities or persons with chronic diseases. Households with elderly members or children under-five years were also more likely to enrol. Poor understanding of risk pooling deterred people from joining the scheme and was the main reason for not renewing membership. On the supply side, poor quality of public care services, the limited benefit package and a lack of provider choice were the main factors for low enrolment. Conclusions Determinants of CHF membership are diverse and improving the quality of health services and expanding the benefit package should be prioritised to expand voluntary health insurance coverage.
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Affiliation(s)
- Jane Macha
- Ifakara Health Institute, P.O BOX 78373, Plot 463, Kiko Ave., Mikocheni, Dar es Salaam, Tanzania.
| | - August Kuwawenaruwa
- Ifakara Health Institute, P.O BOX 78373, Plot 463, Kiko Ave., Mikocheni, Dar es Salaam, Tanzania.
| | - Suzan Makawia
- Ifakara Health Institute, P.O BOX 78373, Plot 463, Kiko Ave., Mikocheni, Dar es Salaam, Tanzania.
| | - Gemini Mtei
- Ifakara Health Institute, P.O BOX 78373, Plot 463, Kiko Ave., Mikocheni, Dar es Salaam, Tanzania.
| | - Josephine Borghi
- Ifakara Health Institute, P.O BOX 78373, Plot 463, Kiko Ave., Mikocheni, Dar es Salaam, Tanzania. .,London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Haile M, Ololo S, Megersa B. Willingness to join community-based health insurance among rural households of Debub Bench District, Bench Maji Zone, Southwest Ethiopia. BMC Public Health 2014; 14:591. [PMID: 24920538 PMCID: PMC4074337 DOI: 10.1186/1471-2458-14-591] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though Ethiopia bears high burden of diseases, utilization of modern health care services is limited. One of the reasons for low utilization of healthcare services is the user-fee charges. Moving away from out-of-pocket charges for healthcare at the time of use is an important step towards averting the financial hardship associated with paying for health service. Prepaid plans for health are not accustomed in Ethiopia. Therefore, social and community based health insurance schemes were introduced since 2010.In this study, willingness of rural households in Debub Bench District, to join community based health insurance was assessed. METHOD Cross-sectional community based study was conducted in Debub Bench District in March 2013 using a pretested structured questionnaire. Two stage sampling technique was used to select 845 households as study units which were allocated to the kebeles proportionately. The sampled households were selected using simple random sampling technique. Data were entered into EPIDATA 3.0 and analyzed with SPSS version 20. RESULT Among 845 sampled households, 808 were interviewed (95.6% response rate). About 78% of the respondents were willing to join the scheme. Most of demographic, socioeconomic variables and social capital were found to be significantly associated with willingness to join community based health insurance. CONCLUSION If the scheme is initiated in the district, majority of the households will enroll in the community based health insurance. Farmers, the married households, Bench ethnic groups and illiterate, the dominant segments of the population, are more likely to enroll the schemes. Therefore initiation of the scheme is beneficial in the district.
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Affiliation(s)
- Melaku Haile
- Aman College of Health Sciences, Southern Nations, Nationalities and People’s Regional Health Bureau, P.O. Box 240, Mizan-Aman, Ethiopia
| | - Shimeles Ololo
- Department of Health Services Management, Jimma University, Jimma, P.O. Box 371, Ethiopia
| | - Berhane Megersa
- Department of Monitoring and Evaluation, Jimma University, Jimma, P.O. Box 371, Ethiopia
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Nosratnejad S, Rashidian A, Mehrara M, Akbari Sari A, Mahdavi G, Moeini M. Willingness to pay for the social health insurance in Iran. Glob J Health Sci 2014; 6:154-63. [PMID: 25168979 PMCID: PMC4825503 DOI: 10.5539/gjhs.v6n5p154] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/17/2014] [Indexed: 11/24/2022] Open
Abstract
Objective: The substantial level of out-of-pocket expenditure for health care by the population causes policy makers to draw particular attention to the proposal of a social health insurance for uninsured members of the community. Hence, it is essential to gather reliable information about the amount of Willingness To Pay (WTP) for health insurance. We assessed the WTP for health insurance in Iran in order to suggest an affordable social health insurance. Method: The study sample included 300 household heads in all Iranian provinces. The double bounded dichotomous choice approach was used to elicit the WTP. Result: The average WTP for social health insurance per person per month was 137 000 Rial (5.5 $US). Household heads with higher levels of education, income and those who worked had more WTP for the health insurance. Besides, the WTP increased in direct proportion to the number of insured members of each household and in inverse proportion to the family size. Conclusions: From a policy point of view, the WTP value can be used as a premium in a society. An important finding of this study is that although households’ Willingness To Pay is not more than the total insurance premium, households are willing to pay more than the premium they ought to pay for health insurance coverage. That is, total insurance premium is 150 000 Rials and households ought to pay approximately half of this sum. This can afford policy makers the ideal opportunity to provide good insurance coverage for medical services according to the need of society.
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Affiliation(s)
- Shirin Nosratnejad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Kimani JK, Ettarh R, Warren C, Bellows B. Determinants of health insurance ownership among women in Kenya: evidence from the 2008-09 Kenya demographic and health survey. Int J Equity Health 2014; 13:27. [PMID: 24678655 PMCID: PMC3973618 DOI: 10.1186/1475-9276-13-27] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. The objective of this study was to examine the determinants associated with health insurance ownership among women in Kenya. METHODS Data came from the 2008-09 Kenya Demographic and Health Survey, a nationally representative survey. The sample comprised 8,435 women aged 15-49 years. Descriptive statistics and multivariable logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with health insurance ownership. RESULTS Being employed in the formal sector, being married, exposure to the mass media, having secondary education or higher, residing in households in the middle or rich wealth index categories and residing in a female-headed household were associated with having health insurance. However, region of residence was associated with a lower likelihood of having insurance coverage. Women residing in Central (OR = 0.4; p < 0.01) and North Eastern (OR = 0.1; p < 0.5) provinces were less likely to be insured compared to their counterparts in Nairobi province. CONCLUSIONS As the Kenyan government transforms the NHIF into a universal health program, it is important to implement a program that will increase equity and access to health care services among the poor and vulnerable groups.
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Affiliation(s)
- James K Kimani
- Population Council, General Accident Insurance House, Ralph Bunche Road, P,O, Box 17643-00500, Nairobi, Kenya.
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Shono A, Kondo M, Ohmae H, Okubo I. Willingness to pay for public health services in rural Central Java, Indonesia: methodological considerations when using the contingent valuation method. Soc Sci Med 2014; 110:31-40. [PMID: 24713191 DOI: 10.1016/j.socscimed.2014.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
In the health sectors of low- and middle-income countries, contingent valuation method (CVM) studies on willingness to pay (WTP) have been used to gather information on demand variation or financial perspectives alongside price setting, such as the introduction of user fees and valuation of quality improvements. However, WTP found in most CVM studies have only explored the preferences that consumers express through their WTP without exploring whether they are actually able to pay for it. Therefore, this study examines the issues pertaining to WTP estimation for health services using the conventional CVM. We conducted 202 household interviews in 2008, in which we asked respondents about three types of public health services in Indonesia and assessed WTP estimated by the conventional CVM as well as in the scenario of "resorting to debt" to recognize their budget constraints. We find that all the demand curves for both WTP scenarios show gaps. Furthermore, the gap for midwife services is negatively affected by household income and is larger for the poor. These results prove that CVM studies on WTP do not always reveal WTP in the latter scenario. Those findings suggest that WTP elicited by the conventional CVM is different to that from the maximum price that prevents respondents from resorting to debt as their WTP. In order to bridge this gap in the body of knowledge on this topic, studies should improve the scenarios that CVM analyses use to explore WTP. Furthermore, because valuing or pricing health services based on the results of CVM studies on WTP alone can exacerbate the inequity of access to these services, information provided by such studies requires careful interpretation when used for this purpose, especially for the poor and vulnerable sections of society.
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Affiliation(s)
- Aiko Shono
- Department of Health Care Policy and Management, Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan; Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Japan.
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroshi Ohmae
- Department of Parasitology, National Institute of Infectious Diseases, Japan
| | - Ichiro Okubo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Japan
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Odeyemi IAO. Community-based health insurance programmes and the National Health Insurance Scheme of Nigeria: challenges to uptake and integration. Int J Equity Health 2014; 13:20. [PMID: 24559409 PMCID: PMC3941795 DOI: 10.1186/1475-9276-13-20] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nigeria has included a regulated community-based health insurance (CBHI) model within its National Health Insurance Scheme (NHIS). Uptake to date has been disappointing, however. The aim of this study is to review the present status of CBHI in SSA in general to highlight the issues that affect its successful integration within the NHIS of Nigeria and more widely in developing countries. METHODS A literature survey using PubMed and EconLit was carried out to identify and review studies that report factors affecting implementation of CBHI in SSA with a focus on Nigeria. RESULTS CBHI schemes with a variety of designs have been introduced across SSA but with generally disappointing results so far. Two exceptions are Ghana and Rwanda, both of which have introduced schemes with effective government control and support coupled with intensive implementation programmes. Poor support for CBHI is repeatedly linked elsewhere with failure to engage and account for the 'real world' needs of beneficiaries, lack of clear legislative and regulatory frameworks, inadequate financial support, and unrealistic enrolment requirements. Nigeria's CBHI-type schemes for the informal sectors of its NHIS have been set up under an appropriate legislative framework, but work is needed to eliminate regressive financing, to involve scheme members in the setting up and management of programmes, to inform and educate more effectively, to eliminate lack of confidence in the schemes, and to address inequity in provision. Targeted subsidies should also be considered. CONCLUSIONS Disappointing uptake of CBHI-type NHIS elements in Nigeria can be addressed through closer integration of informal and formal programmes under the NHIS umbrella, with increasing involvement of beneficiaries in scheme design and management, improved communication and education, and targeted financial assistance.
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Affiliation(s)
- Isaac A O Odeyemi
- Health Economics & Outcomes Research, Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey KT16 0RS, UK.
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Adebayo EF, Ataguba JE, Uthman OA, Okwundu CI, Lamont KT, Wiysonge CS. Factors that affect the uptake of community-based health insurance in low-income and middle-income countries: a systematic protocol. BMJ Open 2014; 4:e004167. [PMID: 24531450 PMCID: PMC3927816 DOI: 10.1136/bmjopen-2013-004167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Many people residing in low-income and middle-income countries (LMICs) are regularly exposed to catastrophic healthcare expenditure. It is therefore pertinent that LMICs should finance their health systems in ways that ensure that their citizens can use needed healthcare services and are protected from potential impoverishment arising from having to pay for services. Ways of financing health systems include government funding, health insurance schemes and out-of-pocket payment. A health insurance scheme refers to pooling of prepaid funds in a way that allows for risks to be shared. The health insurance scheme particularly suitable for the rural poor and the informal sector in LMICs is community-based health insurance (CBHI), that is, insurance schemes operated by organisations other than governments or private for-profit companies. We plan to search for and summarise currently available evidence on factors associated with the uptake of CBHI, as we are not aware of previous systematic reviews that have looked at this important topic. METHODS This is a protocol for a systematic review of the literature. We will include both quantitative and qualitative studies in this review. Eligible quantitative studies include intervention and observational studies. Qualitative studies to be included are focus group discussions, direct observations, interviews, case studies and ethnography. We will search EMBASE, PubMed, Scopus, ERIC, PsycInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL and the Cochrane Library for eligible studies available by 31 October 2013, regardless of publication status or language of publication. We will also check reference lists of included studies and proceedings of relevant conferences and contact researchers for eligible studies. Two authors will independently screen the search output, select studies and extract data, resolving discrepancies by consensus and discussion. Qualitative data will be extracted using standardised data extraction tools adapted from the Critical Appraisal Skills Program (CASP) qualitative appraisal checklist and put together in a thematic analysis where applicable. We will statistically pool data from quantitative studies in a meta-analysis; but if included quantitative studies differ significantly in study settings, design and/or outcome measures, we will present the findings in a narrative synthesis. This protocol has been registered with PROSPERO (ID=CRD42013006364). DISSEMINATION Recommendations will be made to health policy makers, managers and researchers in LMICs to help inform them on ways to strengthen and increase the uptake of CBHI.
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Affiliation(s)
- Esther F Adebayo
- School of Public Health and Family Medicine, University of Cape Town, Observatory, South Africa
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - John E Ataguba
- School of Public Health and Family Medicine, University of Cape Town, Observatory, South Africa
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
- International Health Group, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
- Centre for Evidence-based Health Care, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charles I Okwundu
- Centre for Evidence-based Health Care, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kim T Lamont
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles S Wiysonge
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Evidence-based Health Care, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ridde V, Belaid L, Mallé Samb O, Faye A. Les modalités de collecte du financement de la santé au Burkina Faso de 1980 à 2012. SANTÉ PUBLIQUE 2014. [DOI: 10.3917/spub.145.0715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cofie P, De Allegri M, Kouyaté B, Sauerborn R. Effects of information, education, and communication campaign on a community-based health insurance scheme in Burkina Faso. Glob Health Action 2013; 6:20791. [PMID: 24314344 PMCID: PMC3856340 DOI: 10.3402/gha.v6i0.20791] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 10/31/2013] [Accepted: 11/05/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The study analysed the effect of Information, Education, and Communication (IEC) campaign activities on the adoption of a community-based health insurance (CHI) scheme in Nouna, Burkina Faso. It also identified the factors that enhanced or limited the campaign's effectiveness. DESIGN Complementary data collection approaches were used. A survey was conducted with 250 randomly selected household heads, followed by in-depth interviews with 22 purposively selected community leaders, group discussions with the project management team, and field observations. Bivariate analysis and multivariate logistic regression models were used to assess the association between household exposure to campaign and acquisition of knowledge as well as household exposure to campaign and enrolment. RESULTS The IEC campaign had a positive effect on households' knowledge about the CHI and to a lesser extent on household enrolment in the scheme. The effectiveness of the IEC strategy was mainly influenced by: (1) frequent and consistent IEC messages from multiple media channels (mass and interpersonal channels), including the radio, a mobile information van, and CHI team, and (2) community heads' participation in the CHI scheme promotion. Education was the only significantly influential socio-demographic determinant of knowledge and enrolment among household heads. The relatively low effects of the IEC campaign on CHI enrolment are indicative of other important IEC mediating factors, which should be taken into account in future CHI campaign evaluation. CONCLUSION The study concludes that an IEC campaign is crucial to improving the understanding of the CHI scheme concept, which is an enabler to enrolment, and should be integrated into scheme designs and evaluations.
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Gerstl S, Sauter J, Kasanda J, Kinzelbach A. Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo. PLoS One 2013; 8:e77382. [PMID: 24204819 PMCID: PMC3811982 DOI: 10.1371/journal.pone.0077382] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/08/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Democratic Republic of the Congo is today one of the poorest countries in the world; the health status of the population ranks among the worst in Sub-Saharan Africa. Public health services charge user fees and drug prices. Since 2008, north-eastern Congo is facing a guerrilla war. Malteser International is assisting with free health care for internally displaced persons as well as the general population. Before the incursion the health system was based on user fees. The aim of this study was to determine the socio-economic conditions of the population and to assess their ability to contribute to health care. METHODOLOGY Heads of 552 randomly selected households in 23 clusters in two health zones were interviewed using a standardised questionnaire. FINDINGS The demographic description and socio-economic conditions of the study population were homogenous. Major source of income was agriculture (57%); 47% of the households earned less than US$ 5.5/week. Ninety-two percent of the interviewed households estimated that they would be able to contribute to consultation fees (maximum amount of US$ 0.27) and 79% to the drug prices (maximum amount of US$ 1.10). Six percent opted for free consultations and 19% for free drugs. CONCLUSIONS Living conditions were very basic; the estimated income of the study population was low. Almost half of the population perceived their current living situation as fairly good/good. More than 90% of the study population estimated to be able to contribute to consultation fees and 80% to drug prices. As a result Malteser International suggested introducing flat-rates for health care services. Once the project ends, the population will have to pay again for their health service. One solution would be the introduction of a health care financing system with the goal to reach universal coverage to health care.
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Affiliation(s)
| | - Justin Sauter
- Malteser International, Ariwara, Aru territory, P.O., Democratic Republic of the Congo
| | - Joseph Kasanda
- Malteser International, Ariwara, Aru territory, P.O., Democratic Republic of the Congo
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Robyn PJ, Bärnighausen T, Souares A, Savadogo G, Bicaba B, Sié A, Sauerborn R. Does enrollment status in community-based insurance lead to poorer quality of care? Evidence from Burkina Faso. Int J Equity Health 2013; 12:31. [PMID: 23680066 PMCID: PMC3665463 DOI: 10.1186/1475-9276-12-31] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 05/03/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In 2004, a community-based health insurance (CBI) scheme was introduced in Nouna health district, Burkina Faso, with the objective of improving financial access to high quality health services. We investigate the role of CBI enrollment in the quality of care provided at primary-care facilities in Nouna district, and measure differences in objective and perceived quality of care and patient satisfaction between enrolled and non-enrolled populations who visit the facilities. METHODS We interviewed a systematic random sample of 398 patients after their visit to one of the thirteen primary-care facilities contracted with the scheme; 34% (n = 135) of the patients were currently enrolled in the CBI scheme. We assessed objective quality of care as consultation, diagnostic and counselling tasks performed by providers during outpatient visits, perceived quality of care as patient evaluations of the structures and processes of service delivery, and overall patient satisfaction. Two-sample t-tests were performed for group comparison and ordinal logistic regression (OLR) analysis was used to estimate the association between CBI enrollment and overall patient satisfaction. RESULTS Objective quality of care evaluations show that CBI enrollees received substantially less comprehensive care for outpatient services than non-enrollees. In contrast, CBI enrollment was positively associated with overall patient satisfaction (aOR = 1.51, p = 0.014), controlling for potential confounders such as patient socio-economic status, illness symptoms, history of illness and characteristics of care received. CONCLUSIONS CBI patients perceived better quality of care, while objectively receiving worse quality of care, compared to patients who were not enrolled in CBI. Systematic differences in quality of care expectations between CBI enrollees and non-enrollees may explain this finding. One factor influencing quality of care may be the type of provider payment used by the CBI scheme, which has been identified as a leading factor in reducing provider motivation to deliver high quality care to CBI enrollees in previous studies. Based on this study, it is unlikely that perceived quality of care and patient satisfaction explain the low CBI enrollment rates in this community.
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Affiliation(s)
- Paul Jacob Robyn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- The World Bank, 1818 H Street NW, Washington, DC, USA
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard School of Public Health, Boston, USA
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
| | - Aurélia Souares
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Germain Savadogo
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Nouna Health Research Centre, Ministry of Health, Nouna, Burkina Faso
| | - Brice Bicaba
- Nouna Health District, Ministry of Health, Ouagadougou, Burkina Faso
| | - Ali Sié
- Nouna Health Research Centre, Ministry of Health, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Donfouet HPP, Mahieu PA, Malin E. Using respondents' uncertainty scores to mitigate hypothetical bias in community-based health insurance studies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:277-285. [PMID: 22160944 DOI: 10.1007/s10198-011-0369-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 11/28/2011] [Indexed: 05/31/2023]
Abstract
Community-based health insurance has been implemented in several developing countries to help the poor to gain access to adequate health-care services. Assessing what the poor are willing to pay is of paramount importance for policymaking. The contingent valuation method, which relies on a hypothetical market, is commonly used for this purpose. But the presence of the hypothetical bias that is most often inherent in this method tends to bias the estimates upward and compromises policymaking. This paper uses respondents' uncertainty scores in an attempt to mitigate hypothetical bias in community-based health insurance in one rural setting in Cameroon. Uncertainty scores are often employed in single dichotomous choice surveys. An originality of the paper is to use such an approach in a double-bounded dichotomous choice survey. The results suggest that this instrument is effective at decreasing the mean WTP.
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Shafie AA, Hassali MA. Willingness to pay for voluntary community-based health insurance: findings from an exploratory study in the state of Penang, Malaysia. Soc Sci Med 2013; 96:272-6. [PMID: 23528670 DOI: 10.1016/j.socscimed.2013.02.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
Abstract
Health care in Malaysia is funded primarily through taxation and is no longer sustainable. One funding option is voluntary community-based health insurance (VCHI), which provides insurance coverage for those who are unable to benefit immediately from either a social or private health insurance plan. This study is performed to assess the willingness of Malaysians to participate in a VCHI plan. A cross-sectional study was performed in the state of Penang between August and mid-September 2009 with 472 randomly selected respondents. The respondents were first asked to select their preferred health financing plan from three plans (out-of-pocket payment, compulsory social health insurance and VCHI). The extent of the household's willingness to pay for the described VCHI plan was later assessed using the contingent valuation method in an ex-ante bidding game approach until the maximum amount they would be willing to pay to obtain such a service was agreed upon. Fifty-four per cent of the participants were female, with a mean age of 34 years (SD = 11.9), the majority of whom had a monthly income of Int$1157-2312. The results indicated that more than 63.1% of the respondents were willing to join and contribute an average of Int$114.38 per month per household towards VCHI. This amount was influenced by ethnicity, educational level, household monthly income, the presence of chronic disease and the presence of private insurance coverage (p < 0.05). In conclusion, our study findings suggest that most Malaysians are willing to join the proposed VCHI and to pay an average of Int$114.38 per month per household for the plan.
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Affiliation(s)
- A A Shafie
- Discipline of Social & Administrative Pharmacy, Universiti Sains Malaysia, 11800 Penang, Malaysia.
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Estimating Willingness-to-Pay for health insurance among rural poor in India by reference to Engel's law. Soc Sci Med 2013; 76:67-73. [DOI: 10.1016/j.socscimed.2012.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/25/2012] [Accepted: 10/24/2012] [Indexed: 11/22/2022]
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