Willingness to Participate and Pay into a Community- Based Health Insurance Scheme in Imesi-Ile, a Rural Community in Osun State, Nigeria

Abstract

Aims: Rural dwellers are forced into a vicious circle of lack of financial risk protection to accessing non-optimal care and more poverty from its complications because out-of-pocket payment is their mainstay health care financing option. A sustainable and effective Community-based health insurance scheme will offer some respite. The study aimed to determine household heads’ willingness to participate and pay into a community-based health insurance scheme and the associated factors.
 Study Design: Descriptive cross-sectional.
 Place and Duration of Study: Imesi-Ile, a rural community in Obokun Local government area of Osun state, Nigeria between July and September, 2015.
 Methods: Study population were 147 of the 155 household heads selected via a multi-stage sampling technique. Quantitative data collection was done using a structured questionnaire. The household health status, level of trust and reciprocity in the community, their awareness of a community-based health insurance scheme and their willingness to participate and pay into it using the double contingent valuation method were assessed. Data was analysed using the IBM SPSS version 20 software and statistical significance determined at p<0.05.
 Results: There was a low level of awareness (13.6%), but majority (87.1%) were willing to participate after being informed. Only 54(42.2%) were willing to pay ₦12,000 ($33.3). The maximum amount they were willing to pay was ₦6000 ($16.7). Younger household heads (p=0.009), males (p=0.032), earning ≥₦6000 ($16.7) monthly (p=0.006), and involved in cooperative schemes (p=0.002) were significantly more willing to participate in the scheme. While the sex of the household heads (p=0.006) and mean score on reciprocity (p=0.002) were significantly associated with paying ₦12,000 ($33.3) as premium for a household of 6 persons. The preferred frequency of payment was monthly (53.8%). 
 Conclusion: The household heads in Imesi-Ile community were willing to participate and pay into the scheme. However, further studies on the feasibility and sustainability of implementation is advised.