Health Policy and Planning Advance Access published online on October 26, 2009
Health Policy and Planning, doi:10.1093/heapol/czp046
Willingness to pay for community-based health insurance in Nigeria: do economic status and place of residence matter?
1Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
2Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
3Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
4World Health Organization, African Regional Office, Brazzaville, Congo.
5World Health Organization, Nigeria Country Office, Abuja, Nigeria.
* Corresponding author. Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu-Campus, PMB 01129 UNTH Enugu, Nigeria. E-mail: onwujekwe{at}yahoo.co.uk
Objective We examine socio-economic status (SES) and geographic differences in willingness of respondents to pay for community-based health insurance (CBHI).
Methods The study took place in Anambra and Enugu states, south-east Nigeria. It involved a rural, an urban and a semi-urban community in each of the two states. A pre-tested interviewer-administered questionnaire was used to collect information from a total of 3070 households selected by simple random sampling. Contingent valuation was used to elicit willingness to pay (WTP) using the bidding game format. Data were examined for correlation between SES and geographic locations with WTP. Log ordinary least squares (OLS) was used to examine the construct validity of elicited WTP.
Results Generally, less than 40% of the respondents were willing to pay for CBHI membership for themselves or other household members. The proportions of people who were willing to pay were much lower in the rural communities, at less than 7%. The average that respondents were willing to pay as a monthly premium for themselves ranged from 250 Naira (US$1.7) in a rural community to 343 Naira (US$2.9) in an urban community. The higher the SES group, the higher the stated WTP amount. Similarly, the urbanites stated higher WTP compared with peri-urban and rural dwellers. Males and people with more education stated higher WTP values than females and those with less education. Log OLS also showed that previously paying out-of-pocket for health care was negatively related to WTP. Previously paying for health care using any health insurance mechanism was positively related to WTP.
Conclusion Economic status and place of residence amongst other factors matter in peoples’ WTP for CBHI membership. Consumer awareness has to be created about the benefits of CBHI, especially in rural areas, and the amount to be paid has to be augmented with other means of financing (e.g. government and/or donor subsidies) to ensure success and sustainability of CBHI schemes.
Key Words: Community-based health insurance, equity, willingness to pay, contingent valuation, Nigeria
Accepted for publication 23 July 2009.