Willingness to pay for social health insurance and its determinants among public servants in Mekelle City, Northern Ethiopia: a mixed methods study

Abstract

BackgroundOwing to lack of adequate healthcare financing, access to at least the basic health services is still a problem in Ethiopia. With the intention of raising funds and ensuring universal health coverage, a mandatory health insurance scheme has been introduced. The Community Based Health Insurance has been implemented in all regions of the country, while implementation of social health insurance was delayed mainly due to resistance from public servants. This study was, therefore, aimed to assess willingness to pay for social health insurance and its determinant factors among public servants in Mekelle city, Northern Ethiopia.MethodsA concurrent mixed approach of cross-sectional study design using double bound dichotomous choice contingent valuation method and qualitative focus group discussions was employed. A total 384 public servants were recruited from randomly selected institutions and six focus group discussions (n = 36) were carried out with purposively selected respondents. Participants’ mean willingness to pay (WTP) and independent predictors of WTP were identified using an interval data logit model. Qualitative data were analyzed using thematic analysis.ResultsFrom the 384 participants, 381 completed the interview, making a response rate of 99.2%. Among these respondents 85.3% preferred social health insurance and were willing to pay for the scheme. Their estimated mean WTP was 3.6% of their monthly salary. Lack of money to pay (42.6%) was the major stumbling block to enrolling in the scheme. Respondents’ WTP was significantly positively associated with their level of income but their WTP decreased with increasing age and educational status. On the other hand, a majority of focus group discussion participants were not willing to pay the 3% premium set by the government unless some preconditions were satisfied. The amount of premium contribution, benefit package and poor quality of health service were the major factors affecting their WTP.ConclusionThe majority of the public servants were willing to be part of the social health insurance scheme, with a mean WTP of 3.6% of their monthly salary. This was greater than the premium proposed by the government (3%). This can pave the way to start the scheme but attention should focus on improving the quality of health services.Electronic supplementary materialThe online version of this article (10.1186/s12962-019-0171-x) contains supplementary material, which is available to authorized users.

Willingness to join and pay for Social Health Insurance among Public Servants in Arba Minch town, Gammo Zone, Southern Ethiopia

“…Among the respondents who were willing to join the scheme, only one fourth were willing to pay less than or equals to 1%, and few respondents were willing to pay 1-2 % and 2-3% of their gross monthly salary. This finding is consistent with a study conducted in Mekelle city, Northern Ethiopia (17).…”

“…In our case the study subjects were selected from different public servant groups with variable range of monthly income. On the other hand, the current finding is lower than studies conducted on government employees in Mekelle city, on teachers in Wolaita Sodo, on civil servants in Northwest Ethiopia, Kampala (Uganda), and Malaysia (9,10,(17)(18)(19)(20). Since awareness of the scheme drives for demand, this might be attributed to low awareness of the scheme in our study area.…”

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

“…This is also evidenced from studies conducted among teachers in southern Ethiopia; which explains that teachers with higher educational status are more likely WTP for SHI (13). A higher educational status also showed a positive association with WTP in different studies conducted in Iran, Bangladesh, Nigeria, and Northern Ethiopia (14,18,20,21). Systematic review of WTP for health insurance in low and middle-income countries also indicated that the level of education affects WTP (7).…”

“…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.…”

“…The fact that HCP are getting health services for free, the WTP among higher educational status in this case HCP is found to be lower. Regarding family monthly income, many studies conducted in low and middle-income countries supported that better income has a positive association with WTP (7,17,18,20,(23)(24)(25)(26)(27). For instance, a study conducted in Bangladesh revealed that WTP increased 0.196% with each 1% increase in monthly income (14).…”