Patients’ willingness to pay for the treatment of tuberculosis in Nigeria: exploring own use and altruism

Abstract

BackgroundAlthough, current treatment services for Tuberculosis (TB) in Nigeria are provided free of charge in public facilities, the benefits (value) that patients attach to such service is not known. In addition, the prices that could be charged for treatment in case government and its partners withdraw from the provision of free services or inclusion of the services in health insurance plans are not known. Hence, there is a need to elicit the maximum amounts that patients are willing to pay for TB treatment services, both for themselves and for the very poor patients that may not be able to pay if some user fees are introduced (altruistic willingness to pay).MethodsA pretested interviewer-administered questionnaire was used to elicit the maximum willingness to pay (WTP) for TB treatment services from TB patients in a tertiary hospital in southeast Nigeria. WTP was elicited using the bidding game question format after a scenario was presented to the respondents. Data was analysed using tabulations. Tobit regression models were used to examine the validity of the elicited WTP for own use and altruistic WTP.ResultsThe results show that those aged 30 years and below constituted more than two-fifth (43.2%) of the respondents. More than half of the respondents (52.8%) were not employed. 100 (80.0%) of the respondents were willing to pay for their own use of TB treatment services while 78(62.4%) of the respondents were willing to make altruistic contributions so that the very poor could benefit from the TB services. A Tobit regression analysis of maximum WTP for TB for own use shows that respondents were willing to pay maximum amounts at different statistically significant levels. The results equally show that altruistic WTP was positively and statistically significantly related to the employment status, distance from UNTH and global seriousness of TB.ConclusionsMost patients positively valued the provision of free TB services and were willing to pay for TB treatment for own use. The better-off ones were also willing to make altruistic contributions. Free provision of TB treatment services is potentially worthwhile, but there is potential scope for continuation of universal provision of TB treatment services, even if the government and donors scale down their financing of the services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0574-2) contains supplementary material, which is available to authorized users.

Governance of tuberculosis control programme in Nigeria

“…The findings about transaction cost is consistent with evidence of high cost of TB care despite free care policy in Burkina Faso, South Africa and China [17, 18, 76] and point to the need to include TB in universal health coverage schemes that offer financial protection [24]. The UHC schemes, which could also harness altruistic contributions, would address the need of the poor and vulnerable population and enhance sustainability of the TB programme [55, 76].…”

“…Stigma is high, worse among women with TB and fuelled by misconceptions about TB [3, 28, 37, 45, 52–54]. However, the willingness to pay for TB services for own use and altruistic payments for the poor to have access to TB services are high [55]. Financial incentive was also found to improve TB treatment outcomes in rural Nigeria [56].…”

HeAlth System StrEngThening in four sub_Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies

“…The adapted surveys assess willingness to pay for two common surgical problems, one emergency and one elective (appendicitis and hernia). (35)…”

HeAlth System StrEngThening in four sub-Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies

“… 3 3 Ethiopia Amharic and English Adapted version of the Client Service Receipt Inventory (CSRI) to examine costs associated with the surgical condition [ 46 ]. 3 3 Ethiopia Amharic and English Adapted version of Willingness to Pay Survey [ 47 ]. 3 3, 7 Ethiopia Amharic and English Hospital Survey on Patient Safety Culture (HSOPS) [ 48 ].…”