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

Abstract

ObjectiveAccess to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature.MethodsWe systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP.Result16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP.ConclusionsThe WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

Willingness to Pay for Social Health Insurance and Associated Factors among Health Care Providers in Addis Ababa, Ethiopia

“…Data was collected using an interview questionnaire which was prepared by reviewing similar WTP studies and modified to fit the local context (8,11,(16)(17)(18)(19)(20)(21)(22). It was pretested among 10% of the sample size of the study participants, which were not included in the actual study.…”

“…If the answer was "yes," the interviewer increased the bid by 1% until the respondent says "no" and vice versa. Finally, those who chose 3% and above are considered as WTP yes (16,17,23).…”

Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations

“…In addition, there is no clear enforcement mechanism by which to ensure enrolment under a compulsory approach for the informal sector. Finally, a recently published systematic review of WTP for health insurance in low‐ and middle‐income countries found that the WTP for health care insurance among rural households to be just below 2 per cent of GPD per capita (Nosratnejad, Rashidian and Dror, ). In Cambodia, 2 per cent of GPD per capita equates to USD 14.98 per year, or just USD 3.48 per person per year.…”

Extending health insurance coverage to the informal sector: Lessons from a private micro health insurance scheme in Lagos, Nigeria

“…Nevertheless, enrollment in the MHI plan priced at levels for which clients had previously reported WTP remained low. A growing body of research suggests that WTP surveys frequently underestimate actual willingness or ability to pay, yet administrative data and key informant interviews suggested other factors may ultimately limit interest and use of outpatient services . For example, few clients reported seeking care from outpatient providers covered by the health insurance, citing lost time, transportation costs, and the opportunity costs of lost income.…”