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

Willingness to pay for social health insurance in Ethiopia: A systematic review and meta-analysis

Background

Ethiopia plans to introduce social health insurance with the aim of giving recipients high-quality, long-term universal health care. It was anticipated to be fully operational in 2014. However, due to strong opposition from public employees, the implementation has been delayed multiple times. As a result, more and more studies have been conducted to collect evidence about the issue. However, there is no national pooled evidence regarding the willingness to pay for the scheme. Thus, this review aimed to evaluate the willingness to pay for social health insurance and associated factors in Ethiopia.

Methods

On September 1, 2022, database searches were conducted on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Based on this search, 19 studies were included in the review. The risk of bias for the included studies was assessed using Joana Briggs Institute checklists. The data were extracted using Microsoft Excel. RevMan-5 was used to conduct the meta-analysis. The effect estimates assessed were the odds ratios at a p-value <0.05 with a 95% CI using the random effect model.

Results

The pooled willingness to pay for social health insurance was 42.25% and was found to be affected by sociodemographic, health and illness status, health service related factors, awareness or knowledge level, perception or attitude toward the scheme, and factors related to the scheme. The pooled result showed that the willingness of participants to pay for the scheme was 16% less likely (OR = 0.84; 95% CI: 0.52-1.36). When the outlier was unchecked, the willingness to pay became 42% less likely (OR = 0.58; 95% CI: 0.37-0.91). The lowest willingness to pay for the scheme was in the Oromia region, while the highest was in Harar. Professionally, teachers were 3.22 times more likely to pay for the scheme (OR = 3.22; 95% CI: 1.80-5.76) than health professionals.

Conclusion

The willingness to pay for social health insurance was low, <50%, particularly among health professionals, which urges the Ethiopian health insurance service to deeply look into the issue.

Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey

BACKGROUND

National Health Insurance (NHI) in Indonesia requires an appropriate cost-sharing policy, particularly for diseases that require the largest financing. This study examined factors that influence willingness to pay (WTP) for cost-sharing under the universal health coverage scheme among patients with catastrophic illnesses in Yogyakarta, Indonesia.

METHODS

This was a cross-sectional study using structured questionnaires through direct interviews. The factors related to the WTP for cost-sharing under the NHI scheme in Indonesia were identified by a bivariable logistic regression analysis.

RESULTS

Two out of every five (41.2%) participants had willingness to pay for cost-sharing. Sex [AOR = 0.69 (0.51, 0.92)], education [AOR = 1.54 (0.67, 3.55)], family size [AOR = 1.71 (1.07, 2.73)], occupation [AOR = 1.35 (0.88, 2.07)], individual income [AOR = 1.50 (0.87, 2.61)], household income [AOR = 1.47 (0.90, 2.39)], place of treatment [AOR = 2.54 (1.44, 4.45)], a health insurance plan [AOR = 1.22 (0.87, 1.71)], and whether someone receives an inpatient or outpatient service [AOR = 0.23 (0.10, 0.51)] were found to affect the WTP for a cost-sharing scheme with p < 0.05.

CONCLUSION

Healthcare (place of treatment, health insurance plan, and whether someone receives an inpatient or outpatient service) and individual socioeconomic (sex, educational, family size, occupational, income) factors were significantly related to the WTP for cost-sharing.

Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures

Social health insurance (SHI) is a form of health finance mechanism that had been implemented in many countries to achieve universal health care (UHC). To emulate the successes of SHI in many developed countries, many developing and middle-income countries (MICs) have attempted to follow suit. However, the SHI implementation has problems and obstacles. Many more obstacles were observed despite some successes. This scoping review aimed to study the various developments of SHI globally in its uses, implementation, successes, and obstacles within the last 5 years from 2017 to 2021. Using three databases (i.e., PubMed, EBSCO, and Google Scholar), we reviewed all forms of articles on SHI, including gray literature. The PRISMA-ScR protocol was adapted as the guideline. We used the following search terms: social health insurance, national health insurance, and community health insurance. A total of 57,686 articles were screened, and subsequently, 46 articles were included in the final review. Results showed that the majority of SHI studies were in China and African countries, both of which were actively pursuing SHI programs to achieve UHC. China was still regarded as a developing country. There were also recent experiences from other Asian countries, but only a few from South America. Implementing SHI to achieve UHC was desirable but will need to consider several factors and issues. This was especially the case in developing and MICs. Eventually, full UHC would only be possible with a combination of general taxation and SHI.

Determinants of patients' satisfaction and trust toward healthcare service environment in general practice clinics

This study aimed to examine the healthcare service environment, patients' experience, and responses toward healthcare services in private general practice (GP) clinics. Self-administered questionnaires were used for collecting data from 367 respondents with prior experience in visiting the general practice clinics in Malaysia. SmartPLS statistical tool was used to test the underlying hypotheses. The results revealed that ambiance, service delivery, interior decor, and cleanliness had a significant influence on patients' trust and satisfaction while the exterior design is neither associated with satisfaction nor trust. Patients' satisfaction and trust had a higher significant effect on their repatronage intention, willingness to pay for a premium healthcare service, and engagement in word-of-mouth for healthcare services. In practice, both the service delivery and ambiance features of the healthcare services environment might be optimized by GP clinics. This research provides significant insights from the patients' perspective toward the GP clinics' healthcare services environment.

Willingness to pay for complementary health insurance in Iran: Contingent valuation approach

BACKGROUND

The Iranian health system is based on social health insurance, which is responsible for providing access to basic health care. In addition to basic treatment insurance, complementary health insurance (CHI) offers introductory packages that include surplus services. We recently observed an increase in Iran's health insurance loss coefficient, from 16.5% to 90.4% in 2017.

AIM

To determine the willingness to pay (WTP) for (CHI).

METHODS

We attempted to determine the WTP for CHI in this study to understand better the potential market and the factors that influence CHI demand. The study surveyed 1023 households in the Kerman Province. A questionnaire developed by the researcher was used in this study, based on the principles of contingent valuation and the bidding game method principles. In each scenario, the factors affecting people's WTP, the demand function, and the effective factors on demand were determined using linear multivariate regression using the ordinary least squares method.

FINDINGS

The average WTP was $ 7.01, $ 12.57, $ 16.19, and $ 18.73 for the first to fourth scenarios, respectively. The demand elasticity for health insurance increased from the first to the fourth scenario, indicating that demand is expandable. On the other hand, it was observed that risk aversion dictates the demand for CHI.

CONCLUSION

Contrary to the insurance claims theory, demand for CHI did not reverse. To this end, insurance fund policymakers can avoid risks and high financial costs by identifying risk-averse individuals.