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Tan RTH, Abdul Rasid SZ, Wan Ismail WK, Tobechan J, Tan ETY, Yusof AN, Low JH. Willingness to Pay for National Health Insurance: A Contingent Valuation Study Among Patients Visiting Public Hospitals in Melaka, Malaysia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:255-267. [PMID: 34927225 DOI: 10.1007/s40258-021-00691-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Malaysian public healthcare system is tax funded, with healthcare costs highly subsidized by the Government. The current health financing is not sustainable to cover all the healthcare resources. Introducing a national health insurance (NHI), a prepayment method, would protect the population from financial hardship by reducing out-of-pocket payment, minimizing the barrier to accessing health and achieving equitable healthcare. Studies on the willingness to pay (WTP) for NHI are available in different contexts; however, little was found in Malaysia. In addition, factors affecting the WTP for NHI have been less researched in the Malaysian context. OBJECTIVE This study investigates the WTP for NHI and factors influencing it in Melaka, Malaysia. METHOD Using the contingent valuation method, the researchers distributed a pre-tested self-administered questionnaire to 489 respondents in three leading public hospitals from 1 to 9 November 2019. Multi-stage sampling forms the selection of respondents. Respondents were presented with a hypothetical scenario on NHI and asked whether they would be willing to pay for NHI. Chi-square was used to examine the association between categorical independent variables and WTP for NHI, and binary logistic regression was applied to determine the variables with the most predictive effect towards WTP for NHI. RESULTS Out of 462 usable responses, 344 respondents (74.5%) were willing to pay for NHI. The majority (51.3%) of the respondents were willing to pay 15 Malaysian Ringgit (3.70 US dollars) or more for the NHI scheme. Chi-square analysis revealed that age, marital status, education level, employment status, chronic diseases, and perception towards NHI were significantly associated with WTP for NHI. Binary regression analysis found that marital status and perception towards NHI have the most predictive effect on respondents' WTP for NHI. CONCLUSION This study revealed that the majority of the respondents are willing to pay for NHI if implemented in Malaysia. The findings lay a foundation for implementing a future NHI framework in Malaysia and reference future health financing research.
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Affiliation(s)
- Robin Tiow Heng Tan
- Pharmaceutical Services Division, Melaka State Health Department, Ministry of Health, Melaka, Malaysia.
| | - Siti Zaleha Abdul Rasid
- Azman Hashim International Business School, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
- University of Business and Technology, Jeddah, Saudi Arabia
| | | | - Janiza Tobechan
- Melaka General Hospital, Ministry of Health, Melaka, Malaysia
| | | | | | - Jia Hui Low
- Jasin Hospital, Ministry of Health, Melaka, Malaysia
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Kaambwa B, Chen G, Khadka J, Milte R, Mpundu-Kaambwa C, Woods TJ, Ratcliffe J. A preference for quality: Australian general public's willingness to pay for home and residential aged care. Soc Sci Med 2021; 289:114425. [PMID: 34673356 DOI: 10.1016/j.socscimed.2021.114425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 02/04/2023]
Abstract
In Australia and many other countries internationally, aged care services are provided to older people in their own homes or residential care facilities. The majority of these services are funded by the federal government using taxpayer contributions from the general public. However, the monetary value Australians place on aged care services, and the factors that predict this value, have not been examined. We, therefore, sought to determine the general public's willingness to pay (WTP) for aged care services and examine which factors influence this WTP. A cross-sectional contingent valuation survey was administered to a nationally representative cohort of 10,285 Australians between September and October 2020 from the general population aged 18 years and over. Respondents were asked to indicate their WTP values for satisfactory and high-quality aged care services to be provided in the future. A two-part regression model was used to explain what factors explained variation in WTP. In total, 80% (61%) of respondents were willing to pay to access satisfactory (high) quality home care (counterpart figures for residential care were 64% (45%)). On average, respondents were willing to pay between $126 and $158 ($145 and $237) per week to receive satisfactory-quality (high-quality) home care and between $333 and $520 ($308 and $680) per week for satisfactory-quality (high-quality) residential care. Respondents were willing to pay an additional $120 per week on average to access high-quality aged care. Higher WTP values were generally associated with being younger, male, recent experience with aged care through a close family member accessing aged care and ability to pay. These results suggest general public support for payment of individual co-contributions to access aged care services in the future.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics, College of Medicine & Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, South Australia, 5042, Australia.
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, 3145, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Taylor-Jade Woods
- Health Economics, College of Medicine & Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
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Jabar M, Regadio C, Collado Z. Knowledge on and Membership in PhilHealth: The Case of Overseas Filipino Workers. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:677-687. [PMID: 34233605 DOI: 10.1080/19371918.2021.1942377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This paper describes the level of knowledge on and membership in PhilHealth (Philippine Health Insurance Corporation) among Overseas Filipino Workers (OFWs). It analytically examines the sociodemographic predictors of knowledge on and membership in PhilHealth. Results reveal that 76% of the respondents involved in the study are PhilHealth members. Generally, respondents' level of knowledge about the insurance is moderate. Results of regression analysis reveal that sex/gender (BETA = -.319) and income (BETA = .352) predict membership in PhilHealth. Meanwhile, income (BETA = .295) and marital status (BETA = -.164) predict the level of knowledge on PhilHealth. The results indicate that those with income above PhP40,000 (approximately USD785) are the ones knowledgeable about PhilHealth. Moreover, OFWs with partners are more knowledgeable about the insurance compared to those who are not married or without partners. The results offer several insights regarding PhilHealth membership among OFWs. First, OFWs with higher income tend to become members of PhilHealth. Second, women are less likely to become members, as many of them are working in the service sectors and are generally earning lower income than their male counterparts. This result indicates that women OFWs should be encouraged to become PhilHealth members, especially if their left-behind partners or husbands are not members. This is to ensure that left-behind family members will be able to access health services.
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Carr K, Donaldson C, Wildman J, Smith R, Vernazza CR. An Examination of Consistency in the Incremental Approach to Willingness to Pay: Evidence Using Societal Values for NHS Dental Services. Med Decis Making 2021; 41:465-474. [PMID: 33733897 PMCID: PMC8107443 DOI: 10.1177/0272989x21996329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Willingness to pay (WTP) is used to generate information about value.
However, when comparing 2 or more services using standard WTP techniques,
the amounts elicited from participants for the services are often similar,
even when individuals state a clear preference for one service over another.
An incremental approach has been suggested, in which individuals are asked
to first rank interventions and provide a WTP value for their lowest-ranked
intervention followed by then asking how much more they are willing to pay
for their next preferred choice and so on. To date, evaluation of this
approach has disregarded protest responses, which may give information on
consistency between stated and implicit rankings. Methods A representative sample of the English population (n = 790)
were asked to value 5 dental services adopting a societal perspective, using
a payment vehicle of additional household taxation per year. The sample was
randomized to either the standard or the incremental approach. Performance
for both methods is assessed on discrimination between values for
interventions and consistency between implicit and stated ranks. The data
analysis is the first to retain protest responses when considering
consistency between ranks. Results The results indicate that neither approach provides values that discriminate
between interventions. Retaining protest responses reveals inconsistencies
between the stated and implicit ranks are present in both approaches but
much reduced in the incremental approach. Conclusion The incremental approach does not improve discrimination between values, yet
there is less inconsistency between ranks. The protest responses indicate
that objections to giving values to the dental interventions are dependent
on a multitude of factors beyond the elicitation process.
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Affiliation(s)
- Katherine Carr
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - John Wildman
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Smith
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Hajek A, Enzenbach C, Stengler K, Glaesmer H, Hinz A, Röhr S, Stein J, Riedel-Heller SG, König HH. Determinants of Willingness to Pay for Health Insurance in Germany-Results of the Population-Based Health Study of the Leipzig Research Centre for Civilization Diseases (LIFE-Adult-Study). Front Public Health 2020; 8:456. [PMID: 32984246 PMCID: PMC7485392 DOI: 10.3389/fpubh.2020.00456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate which factors are associated with the willingness to pay (WTP) for health insurance. Methods: The analysis (n = 1,248 individuals) is based on data of a large population-based study—the Health Study of the Leipzig Research Centre for Civilization Diseases (LIFE-Adult-Study). With regard to WTP for health insurance, a contingent valuation method with a payment card was used. Several explanatory variables were included. For example, personality factors (in terms of agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience) were assessed using the NEO-16 Adjective Measure. Results: Average WTP for health insurance per month equaled about €240 which corresponds to ~14% of household net equivalent income. Multiple regressions showed that an increased WTP was associated with lower age (β = −1.7, p < 0.001), higher (log) household net equivalent income (β = 153.6, p < 0.001), higher social support (β = 2.0, p < 0.05), and private health insurance (β = 131.1, p < 0.001). Furthermore, an increased WTP for health insurance was associated with higher openness to experience (β = 10.1, p < 0.05), whereas it was not associated with agreeableness, conscientiousness, extraversion, and neuroticism. Conclusion: The quite large amount of average WTP for health insurance may suggest that individuals accept current contributions to health insurances and would probably accept higher contributions. While previous studies mainly focused on individuals in late life, we identified a link between socioeconomic, health-related factors, and personality factors (in terms of openness to experience) and WTP in the general adult population.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cornelia Enzenbach
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Katarina Stengler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Helios Park Hospital Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Sociology, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Sociology, University of Leipzig, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lauer R, Traub M, Hansen S, Kilian R, Steinacker JM, Kesztyüs D. Longitudinal changes and determinants of parental willingness to pay for the prevention of childhood overweight and obesity. HEALTH ECONOMICS REVIEW 2020; 10:15. [PMID: 32468490 PMCID: PMC7257510 DOI: 10.1186/s13561-020-00266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Willingness to Pay (WTP) is an alternative to measure quality-adjusted life years for cost-effectiveness analyses. The aim was to evaluate longitudinal changes and determinants of parental WTP for the prevention of childhood overweight and obesity. METHODS Longitudinal data from post- (T2) and follow-up (T3) measurements of a school-based health promotion program in Germany. Parental questionnaires included general WTP and the corresponding amount to reduce incidental childhood overweight and obesity by half. Longitudinal differences were examined with the McNemar test for general WTP and the Wilcoxon signed-rank test for the amount of WTP. Regression analyses were conducted to detect determinants. RESULTS General parental WTP significantly decreased from 48.9% to 35.8% (p < 0.001, n = 760). Logistic regression analysis (n = 561) showed that parents with a tertiary education level and a positive general WTP at T2, families with a higher monthly household income, and those with abdominally obese children were significant predictors of general WTP at T3. Median amount of WTP at T3 was €20.00 (mean = €27.96 ± 26.90, n = 274). Assuming a WTP of €0 for those who were generally not willing to pay or did not answer, resulted in a median amount of WTP at T3 of €0 (m = €8.45, sd = €19.58, n = 906). According to linear regression analysis WTP at T2 was the only significant predictor for the amount of WTP at T3 (p = 0.000, n = 181). CONCLUSIONS Despite the decline of general WTP, these results are a reflection of the public awareness of the problem and the need for action. Policy makers should recognize this and initiate sustainable public preventive strategies. TRIAL REGISTRATION DRKS, DRKS00000494. Registered 25 August 2010, https://www.drks.de/drks_web/.
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Affiliation(s)
- Romy Lauer
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Meike Traub
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
- Department of University Sports / Workplace Health Management, Ulm University, Ulm, Germany
| | - Sylvia Hansen
- Ceres - Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, Unversity of Cologne, Cologne, Germany
| | - Reinhold Kilian
- Section Health Economics and Health Services Research, Department of Psychiatry II, Ulm University Medical Center, Günzburg, Germany
| | | | - Dorothea Kesztyüs
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
- Institute of General Practice, Ulm University Medical Center, Ulm, Germany
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