Morbidity, Health Expenditure and Willingness to Pay for Health Insurance amongst the Urban Poor

Abstract

The study aimed to assess the demand for health insurance, gather evidence on willingness to pay (WTP) for health insurance and its determining factors amongst the urban poor in Mumbai. This was as-certained through dichotomous bidding process on 300 households (HHs). The findings reveal characteristics of a low-income group with a burden of disease and treatment financed through out-of-pocket (OOP) expenditure, which is at times catastrophic. These factors justify the demand for health care insurance in the study population expressed by one-third of the population. Results of the multivariate regression model suggest that HHs with presence of morbid conditions and prior experience of inpatient admissions were more likely to join and pay for health insurance. Within the ‘urban poor’, the relatively better-off HHs expressed greater WTP for health insurance. The results clearly indicate the need for a state-subsidized insurance scheme as more than 50 per cent of the people willing to pay expressed their inability to pay more than 1 per cent of the annual income.

Inequitable Access to Health Care by the Poor in Community-Based Health Insurance Programs: A Review of Studies From Low- and Middle-Income Countries

“…Similarly, Asfaw et al found that a 1% increase in income in rural Ethiopia led to an 8.4% increase in the probability of willingness to pay for health insurance 30 . In India, households in the highest wealth quintile were 2.1 times more willing to pay for CBHI compared with those in the lowest quintile 33 . Similarly, in China, Zhanga et al found that willingness to join a CBHI program increased by 0.83% to 1.54% when income increased by 100 Yuan in a year.…”

Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

“…Our academic database searches yielded 1411 hits and the gray literature searches another 8 articles. After screenings of the titles and abstracts, we kept58 studies for full-text review (Fig 1), and thereafter retained 23 articles for detailed review [11][12][13][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Of these, two articles [26] and [20] were excluded after quality assessment.…”

“…The remaining 21 articles relate to 16 distinct studies in the following ten countries: In Asia: Bangladesh [34], China [27], India [18,19,28,33], Iran [21,32] and Vietnam [12]. In Sub-Saharan African: Burkina Faso [16], Cameroon [22,30], Ethiopia [13], Ghana [11], and Nigeria [17,29].…”

“…The sample sizes of the studies varied greatly, from 300 to 3,070 individuals. Seven studies were conducted in rural settings [12,13,19,21,22,29,30], four studies on rural and urban residents [11,16,17,28], one study on urban residents [32], three studies on urban informal sector employees [27,33,34] and one study on the urban poor [18]. Most of the studies involved face-to-face interviews with the respondents.…”

“…We were able to calculate the WTP as percentages of GDP and net national income per capita for all except one included study; that one exception estimated the WTP only as a percentage of household income and did not report monetary values [18]. Four studies that measured household WTP provided enough data to enable us to calculate the corresponding individual WTP [11,12,19,29].…”