Socio-Demographic Predictors of Willingness to Pay for Premium of National Health Insurance: A Cross-sectional Survey of Six Districts in Sierra Leone

Document Type : Original Article

Authors

1 Department of Health Policy Management and Economics, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana

2 University of Makeni (UNIMAK), Makeni, Sierra Leone

3 College of Nursing and Midwifery, Nalerigu, Ghana

4 Sierra Leone Ministry of Health and Sanitation, Makeni, Sierra Leone

5 Medicine San Frontières (MSF), Makeni, Sierra Leone

Abstract

Background 
The government of Sierra Leone introduced Social Health Insurance Scheme as a measure to remove financial barriers that beset the people in accessing health to ensure universal coverage. Under this policy, the citizens were encouraged to subscribe to the scheme to avoid out of pocket payment for healthcare at the point of use. This study was conducted to find out the predictors of willingness among the people to pay for health insurance premium. 
 
Methods 
A cross-sectional study design was employed in six selected districts in Sierra Leone. Quantitative data was collected for this study through the use of semi-structured questionnaire with a sample size of 1185 respondents. Data was analysed into descriptive and inferential statistics using the contingent valuation model. Statistical analysis was run at 5% significant level using Stata version 14.0 software. 
 
Results 
The results showed that majority of the respondent are willing to join and pay a monthly premium of Le 10 000 (US$1.03) with an estimated mean contribution of about Le 14 089 (US$1.44) and the top five predictors of willingness to pay (WTP) were household monthly income, age, district of resident, gender, and educational qualification. 
 
Conclusion 
The findings on predictors of WTP premium of Sierra Leone National Social Health Insurance (SLeNSHI), suggests that the socio-demographic characteristics of the population are important in premium design and payment. Efforts at improving the socio- economic statuses of the population could be helpful in premium design and payment.

Keywords


  1. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet. 2019;393(10187):2233-2260. doi:10.1016/s0140-6736(19)30841-4
  2. Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet. 2017;389(10083):1981-2004. doi:10.1016/s0140-6736(17)30874-7
  3. Kruk ME, Galea S, Prescott M, Freedman LP. Health care financing and utilization of maternal health services in developing countries. Health Policy Plan. 2007;22(5):303-310. doi:10.1093/heapol/czm027
  4. Liu XZ, Wang JL. An introduction to China's health care system. J Public Health Policy. 1991;12(1):104-116.
  5. Onwujekwe O, Onoka C, Nwakoby I, Ichoku H, Uzochukwu B, Wang H. Examining the financial feasibility of using a new special health fund to provide universal coverage for a basic Maternal and Child Health benefit package in Nigeria. Front Public Health. 2018;6:200. doi:10.3389/fpubh.2018.00200
  6. World Health Organization (WHO). The World Health Report: Health Systems Financing: The Path to Universal Coverage. WHO; 2010.
  7. Manyazewal T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Arch Public Health. 2017;75:50. doi:10.1186/s13690-017-0221-9
  8. Blanchet NJ, Fink G, Osei-Akoto I. The effect of Ghana's National Health Insurance Scheme on health care utilisation. Ghana Med J. 2012;46(2):76-84.
  9. Jofre-Bonet M, Kamara J. Willingness to pay for health insurance in the informal sector of Sierra Leone. PLoS One. 2018;13(5):e0189915. doi:10.1371/journal.pone.0189915
  10. Robinson C. Primary health care and family medicine in Sierra Leone. Afr J Prim Health Care Fam Med. 2019;11(1):e1-e3. doi:10.4102/phcfm.v11i1.2051
  11. Boateng KS, Agyei-Baffour P, Boateng D, Rockson GNK, Mensah KA, Edusei AK. Household willingness-to-pay for improved solid waste management services in four major metropolitan cities in Ghana. J Environ Public Health. 2019;2019:5468381. doi:10.1155/2019/5468381
  12. Bärnighausen T, Liu Y, Zhang X, Sauerborn R. Willingness to pay for social health insurance among informal sector workers in Wuhan, China: a contingent valuation study. BMC Health Serv Res. 2007;7:114. doi:10.1186/1472-6963-7-114
  13. Bhattarai K. Households’ willingness to pay for improved solid waste management in Banepa municipality, Nepal. Environ Nat Resour J. 2015;13(2):14-25.
  14. Basaza R, Alier PK, Kirabira P, Ogubi D, Lako RLL. Willingness to pay for National Health Insurance Fund among public servants in Juba City, South Sudan: a contingent evaluation. Int J Equity Health. 2017;16(1):158. doi:10.1186/s12939-017-0650-7
  15. Welivita I. Designing an economic instrument for sustainable solid waste management in the household sector [thesis]. Portsmouth: University of Portsmouth; 2014.
  16. Whittington D. Improving the performance of contingent valuation studies in developing countries. Environ Resource Econ. 2002;22(1):323-367. doi:10.1023/a:1015575517927
  17. Mekonne A, Seifu B, Hailu C, Atomsa A. Willingness to pay for social health insurance and associated factors among health care providers in Addis Ababa, Ethiopia. Biomed Res Int. 2020;2020:8412957. doi:10.1155/2020/8412957
  18. Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015-40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet. 2017;389(10083):2005-2030. doi:10.1016/s0140-6736(17)30873-5
  19. Oyekale AS. Factors influencing households' willingness to pay for National Health Insurance Scheme (NHIS) in Osun state, Nigeria. Studies on Ethno-Medicine. 2012;6(3):167-172. doi:10.1080/09735070.2012.11886435
  20. Carrin G, Waelkens MP, Criel B. Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop Med Int Health. 2005;10(8):799-811. doi:10.1111/j.1365-3156.2005.01455.x
  21. Twum P, Qi J, Aurelie KK, Xu L. Effectiveness of a free maternal healthcare programme under the National Health Insurance scheme on skilled care: evidence from a cross-sectional study in two districts in Ghana. BMJ Open. 2018;8(11):e022614. doi:10.1136/bmjopen-2018-022614
  22. Kotoh AM, Van der Geest S. Why are the poor less covered in Ghana's national health insurance? a critical analysis of policy and practice. Int J Equity Health. 2016;15:34. doi:10.1186/s12939-016-0320-1
  23. Orem JN, Zikusooka CM. Health financing reform in Uganda: how equitable is the proposed National Health Insurance scheme? Int J Equity Health. 2010;9:23. doi:10.1186/1475-9276-9-23
  24. Venkatachalam L. The contingent valuation method: a review. Environ Impact Assess Rev. 2004;24(1):89-124. doi:10.1016/S0195-9255(03)00138-0
  25. Dror DM, Hossain SA, Majumdar A, Pérez Koehlmoos TL, John D, Panda PK. What factors affect voluntary uptake of community-based health insurance schemes in low- and middle-income countries? a systematic review and meta-analysis. PLoS One. 2016;11(8):e0160479. doi:10.1371/journal.pone.0160479
  26. Sydavong T, Goto D, Kawata K, Kaneko S, Ichihashi M. Potential demand for voluntary community-based health insurance improvement in rural Lao People's Democratic Republic: a randomized conjoint experiment. PLoS One. 2019;14(1):e0210355. doi:10.1371/journal.pone.0210355
  27. Salameh AM, Juni MH, Hayati KS. Willingness to pay for social health insurance among academic staff of a public university in Malaysia. Int J Public Health Clin Sci. 2015;2(5):21-32.
  28. Emodi NV, Entele BR, Ogbuagu MN, Emodi CC, Emodi ASA, Okoro FC. Retracted Article: scenario analysis for low carbon development in Nigeria. Cogent Eng. 2016;3(1):1218818. doi:10.1080/23311916.2016.1218818

Articles in Press, Corrected Proof
Available Online from 26 May 2021
  • Receive Date: 16 September 2020
  • Revise Date: 17 April 2021
  • Accept Date: 19 April 2021