Willingness to pay for private health insurance among workers with mandatory social health insurance in Mongolia

Ochirbat Batbold,Christy Pu

doi:10.1186/s12939-020-01343-9

Abstract

BackgroundHigh out-of-pocket health expenditure is a common problem in developing countries. The employed population, rather than the general population, can be considered the main contributor to healthcare financing in many developing countries. We investigated the feasibility of a parallel private health insurance package for the working population in Ulaanbaatar as a means toward universal health coverage in Mongolia.MethodsThis cross-sectional study used a purposive sampling method to collect primary data from workers in public and primary sectors in Ulaanbaatar. Willingness to pay (WTP) was evaluated using a contingent valuation method and a double-bounded dichotomous choice elicitation questionnaire. A final sample of 1657 workers was analyzed. Perceptions of current social health insurance were evaluated. To analyze WTP, we performed a 2-part model and computed the full marginal effects using both intensive and extensive margins. Disparities in WTP stratified by industry and gender were analyzed.ResultsOnly < 40% of the participants were satisfied with the current mandatory social health insurance in Mongolia. Low quality of service was a major source of dissatisfaction. The predicted WTP for the parallel private health insurance for men and women was Mongolian Tugrik (₮)16,369 (p < 0.001) and ₮16,661 (p < 0.001), respectively, accounting for approximately 2.4% of the median or 1.7% of the average salary in the country. The highest predicted WTP was found for workers from the education industry (₮22,675, SE = 3346). Income and past or current medical expenditures were significantly associated with WTP.ConclusionTo reduce out-of-pocket health expenditure among the working population in Ulaanbaatar, Mongolia, supplementary parallel health insurance is feasible given the predicted WTP. However, given high variations among different industries and sectors, different incentives may be required for participation.

Highlights

High out-of-pocket health expenditure is a common problem in developing countries
Overall, < 40% of the participants were satisfied with the current system, but when the study population was stratified by industry, a wide range of satisfaction rate was observed, ranging from 17.1% in public administration to 51.1% in the wholesale and retail trade
The highest predicted willingness to pay (WTP) was found for workers from the education industry (₮22,675, Standard error (SE) = 3346)

Summary

Introduction

High out-of-pocket health expenditure is a common problem in developing countries. We investigated the feasibility of a parallel private health insurance package for the working population in Ulaanbaatar as a means toward universal health coverage in Mongolia. The achievement of universal health care (UHC) coverage, which is one of United Nations’ Sustainable Development Goals (SDG) [1] to reverse the impoverishing effects of out-of-pocket (OOP) health expenditures, is a challenge faced by many developing countries, including Mongolia. Mongolia introduced social health insurance (SHI) in 1994 to achieve UHC; it is compulsory for all public and private sector employees and voluntary for unemployed people. The SHI package, covers only limited inpatient and outpatient services in public and some contracted private health care providers [3]. In Mongolia, OOP expenditure accounted for 41% of the total health expenditure in 2011, causing a severe household financial burden [2]

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