Abstract
BackgroundCôte d’Ivoire’s current health care financing system results from successive reforms undertaken with government funding and international support. The country is moving towards a national compulsory health insurance scheme. This context offered an opportunity to study additional features of health insurance’s potential market in Sub-Sahara Africa developing economy. This study examined patients’ willingness to pay in order to get access to health care when it is needed.MethodsA cross-sectional study was carried out in four tertiary level teaching hospitals from October to December 2017. These hospitals are located in Bouake (service of cardiology) and in Abidjan (two services of Endocrinology-Diabetology and Institute of Cardiology). Monthly willingness to pay was elicited using the contingent valuation method through a bidding game pre-tested interviewer-administered questionnaire. Multinomial logistic regression analysis was performed to predict participants’ willingness to pay.ResultsOut of 450 participants included in the analysis, 22.2% were not willing to pay at least 4.5 euros per month while 7.6%, 26.9%, 29.6%, 5.3% and 8.4% stated to be willing to pay 4.5, 7.5, 15, 30, and 45 euros per month, respectively. Males were 2.3 and 2.5 times more likely to be willing to pay 4.5 or 7.5 and 30 or 45 euros, respectively. However, there was no statistically significant difference between males and females who stated being willing to pay a premium of 15 euros per month as compared to the participants in the reference modality, below 4.5 euros.ConclusionsThe findings indicated that the amount that participants were willing to pay is consistent with other previously elicited. The association of sex with the willingness to pay suggested what might influence the acceptability of and the contribution to the upcoming compulsory health insurance scheme. These pointed out that some market features have to be understood for a successful implementation of this social health insurance scheme.
Highlights
Côte d’Ivoire’s current health care financing system results from successive reforms undertaken with government funding and international support
The 2005 and 2011 World Health Assemblies urged the states members to ensure that health-financing systems include a method for prepayment of financial contributions for health care, with a view of risk sharing among the population to avoid catastrophic health care expenditure and individuals’ impoverishment as a result of seeking care
Since resource mobilization was set on a contribution of 1000 Franc Communauté financière d’Afrique (FCFA) (1.5 euros) per person per month, expenditure planning is based on actuarial calculations and selection of healthcare services and goods to be provided
Summary
Côte d’Ivoire’s current health care financing system results from successive reforms undertaken with government funding and international support. Côte d’Ivoire adopted Bamako Initiative in the 1990s as a result of health sector restructuration to face difficulties encountered by the country in the 1980s. This led to user fees and other out-of-pocket expenditures on health. The MUGEF-CI (Mutuelle générale des fonctionnaires et agents de l’État de Côte d’Ivoire) has the longgest social health insurance experience. It was created in 1973 in the public sector after the termination of free health care for civil servants. A study on the willingness to pay a government’s health insurance plan using the contingent valuation method could help set insurance premiums to provide substantial income for health goods and services with a more efficient and socially equitable health system [5, 6]
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