Willingness to pay for National Health Insurance Fund among public servants in Juba City, South Sudan: a contingent evaluation

Abstract

BackgroundThis study assessed willingness to pay for National Health Insurance Fund (NHIF) among public servants in Juba City. NHIF is the proposed health insurance scheme for South Sudan and aims at achieving universal health coverage for the entire nation’s population. One compounding issue is that over the years, governments’ spending on healthcare has been decreasing from 8.4% of national budget in 2007 to only 2.2% in 2012.MethodsA cross-sectional study design using contingent evaluation was employed; data on willingness to pay was collected from 381 randomly selected respondents and 13 purposively selected key informants working for the national, state and Juba County in September 2015. Qualitative data were analysed using conceptual content analysis. T-tests and linear regressions were performed to determine association between WTP for NHIF and independent variables.ResultsUp to 381 public servants were interviewed, of which 68% indicated willingness to pay varying percentages of total monthly individual income for NHIF. Over two-thirds (67.8%) of those willing to pay could pay up to 5% of their total monthly income, 22.9% could pay up to 10% and the rest could pay 25%. Over 80% were willing to pay up to 50 SSP (1 USD = 10 SSP) premiums for medical consultation, laboratory services and drugs. The main factors influencing the respondents’ decisions were awareness, alternative sources of income, household size, insurance cover and religion.ConclusionsWillingness to pay is mainly influenced by awareness, alternative sources of individual income, household size, insurance cover and religion. Most of the public servants were aware of and willing to pay for NHIF and prefer a premium of up to 5% of total monthly income. There is need to create awareness and reach out to those who do not know about the scheme in addition to a detailed analysis of other stakeholders. Consideration could be made by the Government of South Sudan to start the scheme at the earliest opportunity since the majority of the respondents were willing to contribute towards it.

Feasibility and Sustainability of Community Based Health Insurance in Rural Areas Case Study of Musana, Zimbabwe

“…Age, education, access to educative information and healthcare need and sex of the household head are significant determinants of WTP values for CBHI. These findings are comparable to other studies conducted in low income settings (Basaza et al, 2017;Mogessie et al, 2017;Babatunde et al, 2016;Ahmed et al, 2016;Dror et al, 2016a;Onwujekwe et al, 2010;Lofgren, 2008;Aswaf, 2008, Masanjala andPhiri, 2007). Factors that influence membership to schemes include distance, quality of care and trust.…”

“…A number of WTP studies have been carried out in developing countries including Bangladesh, Ethiopia, India, Malawi, Namibia, Sudan and Vietnam (Basaza et al, 2017;Mogessie et al, 2017;Ahmed et al, 2016;Bawa and Ruchita, 2011;Onwujekwe et al, 2009;Asfaw et al, 2008;Lofgren et al, 2008;Masanjala and Phiri, 2007). Basaza et al, (2017) found of individual income, household size, insurance cover and religion significantly determining WTP in Sudan. Onwujekwe et al (2009) found economic status and place of residence significantly influencing WTP for CBHI membership in Nigeria.…”

Willingness to Pay for Social Health Insurance and Associated Factors among Health Care Providers in Addis Ababa, Ethiopia

“…For instance, in Bangladesh, 87.6% of informal workers were willing to pay for SHI (24) and in Vietnam (72%) (25). A study conducted from Sub-Saharan African countries like Namibia shows that 87% of the study participants have WTP for SHI (16), South Sudan (68.8%) (19), southern Ethiopia (55%) (16), and in north west Ethiopia (80%) (26). The main reason for the lower prevalence of WTP for SHI among HCP in this study is that all government hospitals and most of private hospitals in Addis Ababa provide free health services for their employees and immediate family members.…”

“…Data was collected using an interview questionnaire which was prepared by reviewing similar WTP studies and modified to fit the local context (8,11,(16)(17)(18)(19)(20)(21)(22). It was pretested among 10% of the sample size of the study participants, which were not included in the actual study.…”

Demand for Long-Term Care Insurance in China

“…Thus such studies are rarely used to give policy implications in the design of the schemes [ 14 ]. In low- and middle-income countries, a large number of papers have been published relying on CVM to elicit WTP of the proposed health insurance, aiming at informing policy makers about the financing design of the schemes [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], among which several were based in China [ 22 , 23 ].…”