Willingness-to-pay for Health Insurance: A Comparative Study between Formal and Informal Health-Workers

Abstract

_Introduction_ People in low- to middle-income countries, such as Bangladesh, have less access to healthcare than those in wealthier nations. Bangladeshi households spent approximately Tk 103.46 billion (US $1.49 billion) on out-of-pocket medical costs per year, accounting for 64.3% of total health expenditures. Bangladesh's informal sector employs 85.1% of the total workforce with limited to no health insurance. Less than 1% of Bangladesh's population, mostly those who work in the formal sector, have access to social health protection, which is 14.9% of all jobs. The current comparative study will determine the willingness-to-pay (WTP) for health insurance and associated factors between formal and informal health workers using the contingent valuation method. _Methods and analysis_ This comparative study of WTP and associated factors between formal and informal health workers using the contingent valuation method (CVM) will be conducted over a twelve-month period, from August 2022 to July 2023. A total of 250 health workers will be selected by a purposive sampling technique from various formal and informal work stations in Dhaka City. Out of 250 participants, 125 will be from the formal sector and 125 will be from the informal sector. To collect data, a semi-structured questionnaire will be used via face-to-face interviews. Data will be processed and analyzed using R (version 4.3.0), RStudio (2023.03.1 Build 446) using jmv and DCchoice packages. WTP for social health insurance will be estimated using the DCchoice package. This study will employ a logit model that will consist of a binary dependent variable with follow-up dichotomous choice. Different premium levels will be offered to each participant at different premium levels, to estimate the factors associated with joining the compulsory health insurance scheme. _Ethics and dissemination_ Ethical clearance was obtained from the Institutional Review Board (IRB) of the National Institute of Preventive and Social Medicine (NIPSOM) (Memo no: NIPSOM/IRB/2022/14 (1)) on 29 December 2022. Informed consent will be taken from each participant before data collection. Privacy and confidentiality of data will be maintained strictly. Participants will have full freedom to refuse to participate at any point in the study. The results of the study will be published in scientific, peer-reviewed journals. _Strengths and limitations of this study_ 1. The contingent valuation method is a well-established method of eliciting WTP for health insurance. 2. The current study will be among the first of its nature as it will focus on formal and informal healthcare workers. 3. Starting point bias may affect the result as this type of bias comes with the Double bounded dichotomous choice (DBDC) method used in this study.