Factors associated with willingness to pay for health insurance and pension scheme among informal economy workers in low- and middle-income countries: a systematic review

Abstract

PurposeThe purpose of this paper is to establish the main factors influencing willingness to pay for health insurance and pension schemes among informal workers in low- and middle-income countries (LMICs). Historically, informal economy workers have been excluded from social protection coverage. There is a growing need, interest and policy discourse in LMICs to extend social security to informal economy workers. However, little is known about informal workers' willingness to pay (WTP) for social security services in different LMIC settings.Design/methodology/approachThe authors conducted a systematic review and searched five databases from 1987 to 2017. Included papers focused on “social security”, “social insurance”, “pension”, “informal economy”, “informal sector” and “informal workers” in LMICs. Authors conducted independent data appraisal and data extraction. A total of 1790 papers were identified. After exclusion, 34 papers were included in the analysis. Given the heterogeneous results, the authors performed a narrative synthesis to consolidate the findings of the different studies.FindingsIn total, 34 studies from 17 countries were included in the review, out of which 23 studies focused on health insurance, 7 studies on pension schemes and 4 studies on social security in general. The study showed that income and trust were associated with WTP for both health insurance and pension schemes. In addition, family size, age, education and residential area were common factors for both forms of social security. For health insurance, experience of sickness, attitude and presence of medical doctors as well as distance from the healthcare facility all played a role in determining WTP. For pension schemes, low and flexible contribution rates, benefit package, government subsidies and quality of administration of the schemes influenced enrolment and contributions.Research limitations/implicationsMore evidence is needed for WTP for pensions among informal workers.Practical implicationsThe findings show that socio-economic differences, scheme-type (health or pension) and level of trust influence WTP for health insurance or pension among informal sector workers. The review results suggest that the factors influencing WTP for health insurance and pensions interplay in a complex web of relations. More evidence is needed on WTP for pensions among informal workers.Social implicationsFurther studies are particularly needed on the interrelationship of the influences to WTP, including gender issues, access barriers and socioeconomic factors, among program design issues for social security.Originality/valueThis paper is based on a systematic review methodology and contributes to the discourse on extending social security to informal economy workers based on evidence from various countries.

Willingness to pay for complementary health insurance in Iran: Contingent valuation approach

“…In other words, risk‐averse individuals have a greater need for CHI. This has been evidenced in several studies 48‐51 …”

“…This has been evidenced in several studies. [48][49][50][51] People's risk in all scenarios had no discernible effect. Gustafsson-Wright (2009) asserts in his study that the risk of illness does not affect the desire to purchase insurance policies.…”

Poverty, education and health insurance coverage among women of reproductive ages in the Democratic Republic of the Congo: a cross-sectional and multilevel analysis

“…The existing body of literature on health insurance and universal health coverage (UHC)42 47 48 guided the selection of independent variables included in the analyses, which were grouped into two broad categories: individual-level and household/community-level variables. Individual-level variables included current women’s age (in years), education (in years completed), marital status, religion, working status, index of media exposure, parity, antenatal care attendance and husband/partner’s education.…”

The Effect of Adaptive Selling on the Salesperson Performance of Life Insurance Mediated by Customer Orientation.

“…Researchers generally agree that customer satisfaction is a key factor in determining long-term business success (El Samen and Akroush, 2018;Yu and Chen, 2014;Tseng, 2018;Alnawas and Brown 2017;Miti, Perkio, Metteri, and Atkins, 2020). The salespeople that customers contact the most have been identified as important determinants of the extent to which customers get satisfaction (Tseng, 2018).…”

“…Since the salesperson is an important determinant of customer satisfaction, it can be said that the level of customer orientation for the salesperson will be an important factor in determining the level of customer satisfaction. Such an argument is based on the fact that salespeople who have higher levels of customer orientation will have higher customer satisfaction ratings (Aslam et al 2016;Tseng, 2018;Miti et al, 2020).…”