Willingness to Pay for a Contributory Social Health Insurance Scheme: A Survey of Rural Residents in Akwa Ibom State, Nigeria

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.

Willingness to pay for social health insurance among public civil servants: A cross-sectional study in Dessie City Administration, North-East Ethiopia

“…This result was discovered to be higher than that of studies conducted in Arba Minch, Southern Ethiopia (5.9%) ( 31 ) and at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (17%) ( 32 ), but significantly lower than the findings of many other studies in Jimma, Southwest Ethiopia (90%) ( 13 ), Wolaita Sodo, South Ethiopia (74.4%) ( 15 ), Gondar, Northwest Ethiopia (62.0%) ( 11 ), Mekelle, Northern Ethiopia (85.3%) ( 23 ), Mujja, Ethiopia (37.6%) ( 33 ), Bahir Dar, Northwest Ethiopia (66.6%) ( 20 ), Mekelle, Northern Ethiopia (74.9%) ( 18 ), and public hospitals of Tigrai, Northern Ethiopia (35.5%) ( 34 ). When compared to other findings outside Ethiopia, such as in Akwa Ibom State, Nigeria (82%) ( 35 ), Sarawak, Malaysia (46.7%) ( 16 ), Bangladesh (67.5%) ( 36 ), Juba City, South Sudan (68%) ( 37 ), Public University in Malaysia (72.5%) ( 38 ), Pokhara Lekhnath, Nepal (51%) ( 39 ), Kampala, Uganda (91%) ( 40 ), and central Vietnam (71.6%) ( 41 ), the WTP for SHI in this study was very low. It was, however, much greater than a research conducted in Indonesia's Yogyakarta Province (1.67%) ( 42 ).…”

Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures

“…In a more localized Nigerian study in the rural state of Akwa Ibom, a similar positive support of 82% were willing to pay, but only 30.1% were initially aware of SHI. Again, the support will depend strongly on the income level and family size ( 32 ). Meanwhile, the performance of the SHI scheme in Mongolia was disappointing, and only 40% were satisfied.…”

Willingness to pay for complementary health insurance in Iran: Contingent valuation approach

“…Additionally, teachers who were aware of the insurance had a 2.5-fold greater tendency to pay more than those who were not, according to a study conducted in Ethiopia. [32][33][34][35][36][37] The type of health insurance could explain these distinctions.…”

“…(2021), Setegn et al. (2021), and Batbold and Pu (2021) 27‐47 . However, the literature review revealed no study that examines the WTP for CHI in Iran.…”