Willingness to Pay for Social Health Insurance and Its Determinants Among Public School Teachers in Akaki Kality Sub-City of Addis Ababa City Administration: Ethiopia. Institution-based cross-sectional study

Abstract

Background: Ethiopia is one of the countries with high out-of-pocket payments leading to catastrophic health expenditure. The government of Ethiopia introduced social health insurance scheme to reduce the out-of-pocket payments. However, there is limited evidence on willingness to pay for social health insurance among formal sector employees in the country. This study aimed to assess the willingness to pay for social health insurance and its associated factors among teachers in public school of Addis Ababa. Methods: An institution-based cross-sectional study was conducted from 10th January to 15th April 2022 on 280 teachers. Systematic sampling technique was used; data were collected using pretested self-administered structured questionnaire. The collected data were analyzed using SPSS version 23. Binary logistic regression analysis was performed to estimate crude odds ratios. In the multivariate model, a significant level at p-value of < 0.05 and adjusted odds ratio with 95%CI was used to determine the statistical association between the willingness to pay and explanatory variables. Result: Two hundred eight 74.3%were willing pay for social health insurance. Higher educational status [AOR=5.48; 95%CI (1.80, 16.73)], difficulties associated with healthcare cost [AOR=2.39; 95%CI (1.35, 4.24)], awareness about social health insurance [AOR=5.59; 95%CI (2.98, 10.48)], and knowledge of social health insurance’s benefit package [AOR=5.56; 95%CI (3.07, 10.04)] showed significant positive association with willingness to pay for social health insurance. Perception for poor quality of public health facility and trust on a health insurance agencyshowed significant negative association and teachers lost interest for social health insurance scheme. Conclusions: Three – fourth of the public-school teachers were willing to pay the premium proposed by the government. Higher educational status, difficulties associated with healthcare cost and awareness about social health insurance were the factors that affect positively the willingness to pay for social health insurance among public school teachers. This can pave the way to start the scheme but attention should focus on improving the quality of public health facilities and the trustfulness on health insurance agency.

Willingness to pay for social health insurance in Ethiopia: A systematic review and meta-analysis

“…The WTP for SHI was found to be influenced by sociodemographic factors like education level ( 20 – 22 , 25 , 31 , 32 ), income ( 17 , 19 – 21 , 27 , 28 , 31 , 34 ), age ( 26 , 28 , 31 ), marital status ( 28 , 33 ), occupation or job description ( 28 ), family size ( 29 , 30 , 34 ), and job experience ( 16 ); health and illness status such as self-rated healthiness ( 16 ), the presence of acute ( 20 , 21 , 31 ), and chronic illnesses ( 34 ); health service related factors like previous medical bills ( 16 , 18 , 21 , 22 , 24 , 27 , 28 , 30 , 35 ), referral system ( 26 ), regular medical checkup ( 26 ), and health service quality ( 16 , 19 , 24 – 27 ); awareness or knowledge ( 16 – 18 , 20 – 23 , 27 , 29 , 30 , 32 , 34 , 35 ); perception ( 24 , 31 ); attitude ( 17 , 21 , 27 , 33 , 34 ); and factors related to the scheme such as trust ( 17 , 23 ), premium amount ( 19 ), and the scope of the benefit packages ( …”

Social Health Insurance and Healthcare Seeking Behavior in Urban Ethiopia

“…For instance, in Mekelle, the largest city in the country's Tigray region, a majority (85%) of the 381 public servants were willing to be part of the social health insurance scheme, with a mean WTP of 3.6% of their monthly salary [18]. Although not as high as in Mekelle, surveys amongst teachers in Harar, Wolaita Sodo, Gondar and Akaki Kality (a sub-city of Addis Ababa), yielded WTP rates of between 62% and 74% [19][20][21][22]. A meta-analysis covering 18 studies showed that, on average, about 42% of formal sector workers are WTP for SHI [23].…”