Willingness to pay for private health insurance among workers with mandatory social health insurance in Mongolia

Abstract

Background High out-of-pocket health expenditure is a common problem in developing countries. The employed population, rather than the general population, can be considered the main contributor to healthcare financing in many developing countries. We investigated the feasibility of a parallel private health insurance package for the working population in Ulaanbaatar as a means toward universal health coverage in Mongolia. Methods This cross-sectional study used a purposive sampling method to collect primary data from workers in public and primary sectors in Ulaanbaatar. Willingness to pay (WTP) was evaluated using a contingent valuation method and a double-bounded dichotomous choice elicitation questionnaire. A final sample of 1657 workers was analyzed. Perceptions of current social health insurance were evaluated. To analyze WTP, we performed a 2-part model and computed the full marginal effects using both intensive and extensive margins. Disparities in WTP stratified by industry and gender were analyzed. Results Only < 40% of the participants were satisfied with the current mandatory social health insurance in Mongolia. Low quality of service was a major source of dissatisfaction. The predicted WTP for the parallel private health insurance for men and women was Mongolian Tugrik (₮)16,369 (p < 0.001) and ₮16,661 (p < 0.001), respectively, accounting for approximately 2.4% of the median or 1.7% of the average salary in the country. The highest predicted WTP was found for workers from the education industry (₮22,675, SE = 3346). Income and past or current medical expenditures were significantly associated with WTP. Conclusion To reduce out-of-pocket health expenditure among the working population in Ulaanbaatar, Mongolia, supplementary parallel health insurance is feasible given the predicted WTP. However, given high variations among different industries and sectors, different incentives may be required for participation.

Determinants of patients' satisfaction and trust toward healthcare service environment in general practice clinics

“…While cognitive satisfaction is related to patients' rational judgment of service quality and environment, satisfaction is patients' affective or emotional expression such as pleasure, trust, happiness, and joy upon service encounter. The hospital service environment can influence patient satisfaction and in turn reflect patients' word-of-mouth (Coutinho et al, 2020), repatronage intention (Odoom et al, 2021), and willingness to pay a premium (Batbold and Pu, 2021) toward healthcare service delivery. In their study, Rahman et al (2021b) explained the impact of patients' satisfaction and patients' responses toward healthcare services at general practice clinics.…”

“…Though it is difficult for patients to evaluate the technical aspects of healthcare services, Sahoo and Ghosh (2016) noted service environment as a critical determinant of patients' satisfaction and trust. Furthermore, patient "satisfaction" which is one of many aspects of the patients' experience reflect word-of-mouth (Coutinho et al, 2020), repatronage intention (Odoom et al, 2021), and willingness to pay a premium (Batbold and Pu, 2021) toward healthcare service delivery. "Trust" is another factor that is considered by this study to incorporate patients' experience and has been proven to impact repatronage intention among emergency department patients (Akmaz and Çadirci, 2017) and patients are also willing to pay more for a preferable service environment (Ladhari, 2009).…”

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.…”

“…Therefore, these functions do not consider the effect of changes in income on demand. 37 In all scenarios, risk aversion was the most influential factor affecting responders' demands. In other words, riskaverse individuals have a greater need for CHI.…”

“…(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.…”