Exploring willingness to pay for health insurance and preferences for a benefits package from the perspective of women from low-income households of Karachi, Pakistan

Shifa Salman Habib,Shehla Zaidi

doi:10.1186/s12913-021-06403-6

Abstract

BackgroundAchieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG). In low-middle income countries, micro-health insurance (MHI) schemes have emerged as a useful financing tool for laying grounds for Universal Health Coverage. The aim of this study was to provide evidence for designing a feasible health insurance scheme targeted at urban poor, by exploring preferences for an insurance benefits package and co-payments among women from low-income households in Karachi, Pakistan.MethodsThis was a descriptive cross-sectional study, conducted using household surveys between July–August 2015. A total of 167 female beneficiaries of Benazir Income Support Programme (BISP), a large-scale cash transfer scheme targeted at low-income households, were recruited in Karachi through a mix of convenience and snowball sampling. Hypothetical insurance benefits packages for a prospective health insurance scheme were formulated to capture respondents’ preferences for health insurance benefits package and co-payments. All data was analyzed using Stata (version 13).ResultsRespondents reporting expenditure on OPD and hospitalization in the last 2 weeks were 93.4 and 11.9% respectively. The highest median expenditure was incurred on medicines. Out of the proposed benefits package, a majority (53%) of the study participants opted for the comprehensive benefits package that provided coverage for emergency care, hospitalization, OPD consultation, diagnostic tests and transportation. For the co-payment plan, 38.9% participants preferred no co-payments that is 100% insurance coverage of medicines followed by hospitalization (25.9%). Nearly half of the respondents (49.4%) chose outpatient consultation for 50% co-payment. A majority of the participants (65.3%) agreed to 100% co-payment for the transportation cost.ConclusionHealth insurance schemes can be introduced in urban areas, against collection of micro-payments, to prevent low-income households from facing financial catastrophe. A comprehensive benefits package covering emergency care, hospitalization, OPD consultation, diagnostic tests and transportation, is the most preferred among low-income beneficiaries.

Highlights

Achieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG)
Karachi was selected for the study as an urban center may be a good starting point for an microhealth insurance (MHI) scheme, where there is higher ability to pay for premiums, higher proportion of formal workforce whose salaries can be contributed towards an insurance pool and greater availability of health infrastructure
A majority of the participants (65.3%) agreed for 100% co-payment for the transportation cost (Fig. 3). This is the first study from Pakistan, that contributes towards feasibility of designing a health insurance scheme targeted at low-income urban households by examining their willingness to enroll in such a scheme, preferences for the insurance benefits package and co-payments

Summary

Introduction

Achieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG). In low-middle income countries, microhealth insurance (MHI) schemes have emerged as a useful financing tool for laying grounds for Universal Health Coverage. Achieving universal health coverage (UHC), including provision of financial protection and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG) [1]. In 2015, Pakistan’s federal government launched a national health insurance initiative, Sehat Sahulat Programme which currently covers hospitalization for 6.7 million households, across 86 districts in the country [2] These insurance schemes have been marked by poor utilization, secondary to low insurance literacy among the beneficiaries and lack of empaneled private providers These insurance schemes have been marked by poor utilization, secondary to low insurance literacy among the beneficiaries and lack of empaneled private providers ([2], https://www.aku.edu/news/Pages/News_Details. aspx?nid=NEWS-002320)

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