Abstract
PurposeThe objective of this project is to study the willingness to pay (WTP) for health insurance (HI) of individuals working in the informal sector in Sierra Leone, using a purposely-designed survey of a representative sample of this sector.MethodsWe elicit the WTP using the Double-Bounded Dichotomous Choice with Follow Up method. We also examine the factors that are positively and negatively associated with the likelihood of the respondents to answer affirmatively to joining a HI scheme and to paying three different possible premiums, to join the HI scheme. We additionally analyze the individual and household characteristics associated with the maximum amount the household is willing to pay to join the HI scheme.ResultsThe results indicate that the average WTP for the HI is 20,237.16 SLL (3.6 USD) per adult but it ranges from about 14,000 SLL (2.5 USD) to about 35,000 SLL (6.2 USD) depending on region, occupation, household and respondent characteristics. The analysis of the maximum WTP indicates that living outside the Western region and working in farming instead of petty trade are associated with a decrease in the maximum premium respondents are WTP for the HI scheme. Instead, the maximum WTP is positively associated to being a driver or a biker; having secondary or tertiary education (as opposed to not having any); the number of pregnant women in the household; having a TV; and, having paid for the last medical requirement.ConclusionsIn summary, the various analyses show that a premium for the HI package could be set at approximately 20,000 SLL (3.54 USD) but also that establishing a single premium for all individuals in the informal sector could be risky. The efficient functioning of a HI scheme relies on covering as much of the population as possible, in order to spread risks and make the scheme viable. The impact of the various population characteristics raises the issue of how to rate premiums. In other words, setting a premium that may be too high for a big proportion of the population could mean losing many potential enrollees and might have viability consequences for the operation of the scheme.
Highlights
Sierra Leone has a population of 6.6 M, with an average life expectancy of 56.1 years, despite 41% of the population being under 15 and only 3.7% above 65
The results indicate that the average willingness to pay (WTP) for the health insurance (HI) is 20,237.16 SLL (3.6 USD) per adult but it ranges from about 14,000 SLL (2.5 USD) to about 35,000 SLL (6.2 USD) depending on region, occupation, household and respondent characteristics
The analysis of the maximum WTP indicates that living outside the Western region and working in farming instead of petty trade are associated with a decrease in the maximum premium respondents are WTP for the HI scheme
Summary
Sierra Leone has a population of 6.6 M, with an average life expectancy of 56.1 years, despite 41% of the population being under 15 and only 3.7% above 65. Health care treatments often rely on NGOs, the goodwill of doctors and nurses, and require unaffordable out-of-pocket payments from the population This situation has become especially problematic in light of the Ebola crisis of 2014–2015, which killed around 4,000 persons and may have caused the GDP of Sierra Leone to drop by 21% [2]. The last approach is to use dichotomous choice questions, which, in their simplest form, ask the individual if he/she would be willing to pay an amount X for a described hypothetical good or service. The studies included in Nosratnejad et al.‘s systematic literature review elicit WTP for HI by means of either bidding games, open-ended questions, payment cards, take-it-or-leave-it questions, or double-bounded dichotomous choice [5]
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