Abstract
BackgroundMany low and middle-income countries are increasingly cognisant of the need to offer financial protection to its citizens through pre-payment schemes in order to curb high out of pocket expenditure and catastrophic spending on healthcare. However, there is limited rigorous contextual evidence to make decisions regarding optimal design of such schemes. This study assesses the willingness-to-pay (WTP) for the recently introduced state contributory health insurance scheme (SHIS) in Nigeria.MethodsThe study took place in 6 local government areas in Kaduna state, North-west Nigeria. Data were collected from a household survey using a three-stage cluster sampling approach, with each household having the same probability of being selected. Interviews were conducted with 4000 individuals in 1020 households. Contingent valuation was used to elicit the willing to pay (WTP) for the household using the bidding game technique. The relationship between socioeconomic status and WTP was also examined using logistic regression models.FindingsAbout 82% of the household heads were willing to pay insurance premiums for their households, which came to an average of 513 Naira (1.68 USD) per month per person. The average amount individuals were willing to pay was lower in rural areas (611 Naira) compared to urban areas (463 Naira). These results were influenced by household size, level of education, occupation and household income. In addition, only 65% of the households had the ability to pay the average premium.ConclusionSocioeconomic factors influence individuals’ WTP for contributory health insurance schemes. It is important to create awareness about the benefits of the insurance scheme, especially in rural areas, and in both the formal and informal sectors in Nigeria. WTP information can inform the amount of insurance premiums. However, it is important to consider differences between the WTP and the cost of benefits package to be offered, as the premium amount may need to be subsidized with public financing.
Highlights
In recent years, equitable access to quality healthcare towards universal health coverage (UHC) has become priority in many low and middle-income countries
Willingness to pay for health insurance in Nigeria information can inform the amount of insurance premiums
A total of 985 respondents were interviewed in 6 local government areas (LGAs) in Kaduna State with 72.5% of the respondents from rural areas while the remaining 27.4% were from urban areas
Summary
Equitable access to quality healthcare towards universal health coverage (UHC) has become priority in many low and middle-income countries. Financial protection, which has to do with how much people have to pay out of pocket is an integral component of achieving universal health coverage [1]. Available evidence indicates that per capita spending on health in many low and middle income countries is likely to increase rapidly the long run [5,6,7]. Many low and middle-income countries are increasingly cognisant of the need to offer financial protection to its citizens through pre-payment schemes in order to curb high out of pocket expenditure and catastrophic spending on healthcare. This study assesses the willingness-to-pay (WTP) for the recently introduced state contributory health insurance scheme (SHIS) in Nigeria
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