Willingness to pay for health insurance in the informal sector of Sierra Leone

Abstract

PurposeThe objective of this project is to study the willingness to pay (WTP) for health insurance (HI) of individuals working in the informal sector in Sierra Leone, using a purposely-designed survey of a representative sample of this sector.MethodsWe elicit the WTP using the Double-Bounded Dichotomous Choice with Follow Up method. We also examine the factors that are positively and negatively associated with the likelihood of the respondents to answer affirmatively to joining a HI scheme and to paying three different possible premiums, to join the HI scheme. We additionally analyze the individual and household characteristics associated with the maximum amount the household is willing to pay to join the HI scheme.ResultsThe results indicate that the average WTP for the HI is 20,237.16 SLL (3.6 USD) per adult but it ranges from about 14,000 SLL (2.5 USD) to about 35,000 SLL (6.2 USD) depending on region, occupation, household and respondent characteristics. The analysis of the maximum WTP indicates that living outside the Western region and working in farming instead of petty trade are associated with a decrease in the maximum premium respondents are WTP for the HI scheme. Instead, the maximum WTP is positively associated to being a driver or a biker; having secondary or tertiary education (as opposed to not having any); the number of pregnant women in the household; having a TV; and, having paid for the last medical requirement.ConclusionsIn summary, the various analyses show that a premium for the HI package could be set at approximately 20,000 SLL (3.54 USD) but also that establishing a single premium for all individuals in the informal sector could be risky. The efficient functioning of a HI scheme relies on covering as much of the population as possible, in order to spread risks and make the scheme viable. The impact of the various population characteristics raises the issue of how to rate premiums. In other words, setting a premium that may be too high for a big proportion of the population could mean losing many potential enrollees and might have viability consequences for the operation of the scheme.

Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation

“…This result was related to research done in Sierra Leone, in which 61% of respondents in treatment choice were in public hospitals and Sarawak Malaysia, 14% of participants believed that the government’s responsibility to bear treatment cost. The same reason in Osun state Nigeria, 12.4% were non-willingness to pay and believed that the government alone should pay for healthcare service expenses and at St. Paul’s Hospital Millennium Medical College of Addis Ababa, 13% of the respondents stated that healthcare services should be the responsibility of the government [ 27 , 37 , 38 , 44 , 45 ]. The possible reasons might be due to Government’s responsibility to bear the treatment cost; the possible coverage of medical healthcare costs made them consider insured and risk-neutral (misconception for SHI) employees might not feel a financial burden for seeking treatment.…”

Nexus Among Economic Growth, Education, Health, and Environment: Dynamic Analysis of World-Level Data

“…There are many factors, such as cultural background, social safety aggregate income, and active labor market policies acting as formal or informal mechanisms of insurance, which are systematically different across the county (53), and these factors may affect health conditions via economic growth. Whereas, the socioeconomic inequalities in mental health has widened (54–56). The changes in macroeconomic factors can lead to a change in the health conditions of a population, but a dissimilarity of magnitude for different age groups, ethnicity, education, and gender has been found (57, 58).…”

Willingness to pay for private health insurance among workers with mandatory social health insurance in Mongolia

“…Empirical results from early studies suggest that demand for health insurance is affected by education [ 22 ] and income levels, and the male gender is associated with a higher willingness to pay (WTP) [ 23 , 24 ]. This prompted us to investigate differences in WTP by gender in Mongolia during the transition period when women had a higher education level [ 25 ] but lower wage and fewer job opportunities than men [ 26 ]. There are large differences in earnings that cannot be explained by education and experience.…”

“…We used the contingent valuation (CV) method to examine the preferences of individuals to determine WTP [ 25 , 26 ]. We used a double-bounded dichotomous choice elicitation questionnaire, as used in studies to determine WTP for private health insurance in low- and middle-income countries [ 25 , 27 ].…”

“…Similar to other studies on WTP for developing countries [ 25 , 26 ], we set the initial premium as ₮30,000 (1 USD ≈ ₮2400 in 2018, which means approximately US$12 per month) and then subtracted and added ₮10,000 to the initial bid to estimate WTP.…”