Estimating Willingness-to-Pay for Health Insurance Among Rural Poor in IndiaBy Reference to Engel's Law (original) (raw)
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Estimating rural households’ willingness to pay for health insurance
European Journal of Health Economics, 2004
In many developing countries limited health budgets are a serious problem. Innovative ways to raise funds for the provision of health services, for example, through health care insurance, have a high priority. Health care insurance for rural households shields such patients from unexpected high costs of care. However, there are questions about whether, and how much, rural households are willing to pay to purchase such insurance, as well as the factors determining willingness to pay. In recent years the Iranian government has tried to improve health and medical services to rural areas through a health insurance program. This study was conducted to estimate rural households’ demand and willingness to pay for health insurance. A contingent valuation method (CVM) was applied using an iterative bidding game technique. Data has been collected from a sample of 2,139 households across the country.
Health Policy, 2007
This study, conducted in India in 2005, provides evidence on Willingness to pay (WTP), gathered through a unidirectional (descending) bidding game among 3024 households (HH) in seven locations where micro health insurance units are in operation. Insured persons reported slightly higher WTP values than uninsured. About two-thirds of the sample agreed to pay at least 1%; about half the sample was willing to pay at least 1.35%; 30% was willing to pay about 2.0% of annual HH income as health insurance premium. Nominal WTP correlates positively with income but relative WTP (expressed as percent of HH income) correlates negatively. The correlation between WTP and education is secondary to that of WTP with HH income. Household composition did not affect WTP. However, HHs that experienced a high-cost health event and male respondents reported slightly higher WTP. The observed nominal levels of WTP are higher than has been estimated hitherto.
Inequality in willingness-to-pay for community-based health insurance
Health Policy, 2005
The purpose was to provide information for devising community-based health insurance (CBI) policies that reduce inequality in enrolment and further inequality in access to health services. A two-stage cluster sampling was used in the household survey. Inequalities in willingness-to-pay (WTP) for CBI are examined by expenditure quintile using data collected from a household survey. Interviews were conducted with 2414 individuals, 705 of whom were household heads. A bidding game method was used to elicit WTP. Individuals and households were assigned to 6-month expenditure quintiles. We found that mean and median individual WTP for CBI was significantly higher for higher spending quintiles, as was mean and median household WTP. The curves of cumulative percentage of individual and household WTP shifted rightwards for higher quintiles, implying that at any given premium the lower the quintile the lower the uptake of CBI. The Gini coefficient for individual WTP and household WTP was 0.15 and 0.08, respectively, and for individual 6-month expenditure and household 6-month expenditure is 0.68 and 0.63, respectively. The results imply that the premium needs to be adjusted for income; otherwise, a lower proportion of poor people will enrol in CBI and without exemptions or subsidies the poor will have less access to health services than the rich. Thus, exemptions and subsidies for the poor for enrolling in CBI are an important issue for decision-makers with an objective of improving equity of health and helping the poor to break out of the cycle of poverty. Since the distribution of WTP by household is less unequal than the distribution of WTP by individuals, the household might be a better unit of enrolment in terms of equity than the individual.
WILLINGNESS TO PAY FOR HEALTH INSURANCE IN RURAL INDIA
Healthcare financing in India has become a source of worry for the government, policy makers and the populace most especially the rural poor and economically vulnerable group. It is estimated that out-of-pocket payment dominates the bulk of healthcare financing in India (NSSO, 2006). Health insurance of any form has been identified to play an important role in rural households' access to healthcare and turns the unexpected health expenditure into predictable payments in the form of insurance which in turn encourages households to further invest in the wellbeing of their households (Asgary et al., 2004). It increases the fungibility of funds for these households especially when such insurance schemes are well established and households face relatively low out of pocket payments when they use healthcare services. Such households will be better producers of health and also increase the consumption of health related commodities, which further enhances the status of the household members. In the midst of high cost of health care both at the macro and micro levels, health insurance becomes a viable alternative for financing health care in India. There is growing evidence that the level of health care spending in India – currently at over 6 per cent of its total GDP – is considerably higher than that in many other developing countries. (World Development Report, 1993). It is also a way of mobilising private funds for improving health care delivery at the macro level. Unlike other areas of spending, health treatment is neither regular nor predictable. Most of the time when people fall sick, they tend to adopt various way of coping with such an event this includes selling off personal belongings such as animals, land and other assets. Sometimes, households tend to resort to barrow money from their neighbours, or relatives or friends. This is because there is always a desire to get better again and if possible, quickly. If the individual or household fails in obtaining financial heap, often times the sick individuals has no option than to remain in the state and begin to deteriorate. Others decide at this point to go for cheaper alternatives, which might not be efficacious such as use of traditional healers and medical practitioners. Objective The main objectives of this paper are to estimate the willingness to pay for health insurance scheme in Rural India and to determine the major factors that determine rural households' willingness to pay for the proposed scheme.
Journal of Health Management, 2023
The purpose of this study is to examine determinants of Rural Households" Willingness to pay (WTP) for Community Based Health Insurance Scheme, in Kewiot and EfratanaGedem districts of Amhara region, Ethiopia. A cross-sectional design that followed a quantitative approach was used. Pre-tested structural and interviewer administered questionnaire was used to collect the desired data. A total of 392 sample rural households were taken by systematic random method. The contingent valuation method of double bounded dichotomous choice format (with calibration strategy) is applied to elicit households" willingness to pay for the scheme. An interval regression model is used to estimate the mean willingness to pay and to explore the degree of association between predicted WTP and predictor variables. Households" WTP for the scheme is found significantly associated with factor variables such as gender, education status, family size, level of awareness about the scheme, respondents" trust in the scheme management, family ill health experience, households" perceptions on health service quality, and their annual income level. The mean WTP amount is found 211ETB ($10.5) per annum per household. The result clearly shows that 79 % rural households are willing to pay for the scheme. Therefore, despite these factors affecting the rural households" WTP, there is a potential demand for the community based health insurance scheme. We suggest that, among
Momona Ethiopian Journal of Science, 2023
The study aimed to assess willingness to pay for community-based health insurance and its correlates among households in Wukro and Setit-humera towns, Tigray, Northern Ethiopia for the year 2016. A community-based survey was conducted in Wukro and Setit-humera towns of the Tigray region from August 30 to October 05, 2016. A total of 823 households were enrolled using a two-stage sampling. A structured, pre-tested, and interviewer-administered questionnaire was used. Data were entered and analyzed using SPSS version 20. Frequencies, mean, and median were calculated. Bivariate and multiple variable logistic regressions were fitted. Odds Ratio with 95% CI was used to see the associations between selected independent variables and the outcome variable. Willingness to pay for community-based health insurance (CBHI) in the two towns was 93.4% with 95% CI (91.6-95.0). The median amount of money that households are willingnessto-pay (WTP) was 11.1 USD. The mean amount of money an individual household is willing to pay was significantly higher in Setit-humera than in Wukro town. Participants who knew their monthly income were two times more likely to be willing to pay for CBHI [Adjusted odds ratio (AOR) =2.6, 95% CI; 1.1, 8.1]; and willingness was higher among households who perceived that the cost of care is affordable in health facilities [AOR=2.6, 95% CI; 1.02, 7.1]. The study has shown a high level of willingness to pay for health insurance. Perceived affordability and knowledge of monthly income were significant factors that affect willingness to pay for communitybased health insurance. Therefore, it can be operationalized in urban settings provided that the community is aware and sensitized focusing on the benefits of health insurance. Besides, the premium needs to be carefully set to consider the community's ability to pay.
Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries
Objective Access 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. Methods We 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. Result 16 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. Conclusions The 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
Journal of Health Management, 2011
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)
People's willingness to pay for health insurance in rural Vietnam
Cost Effectiveness and Resource Allocation, 2008
The inequity caused by health financing in Vietnam, which mainly relies on out-ofpocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.