Willingness to Pay to Improve Quality of Public Healthcare Services in Mauritius

Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria

BACKGROUND

Evidence of willingness to pay for kidney replacement therapy is scarce in low-middle-income countries, including Nigeria's Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria.

METHODS

The study adopted a cross-sectional survey design. We used the contingent valuation method to estimate the maximum stated willingness to pay (WTP) for haemodialysis among end-stage kidney disease (ESKD) patients. We obtained informed written consent from respondents before data collection. The socio-demographic characteristics and willingness to pay data were summarized using descriptive statistics. We evaluated the mean differences in respondents' WTP using Mann-Whitney and Kruskal-Wallis tests. All variables that had p < 0.25 in the bivariate analysis were included in the Generalized Linear Model (gamma with link function) to determine the predictors of the WTP for one's and another's haemodialysis. The level of significance in the final model was ρ < 0.05.

RESULTS

About 88.3% and 64.8% of ESKD patients were willing to pay for personal and altruistic haemodialysis, correspondingly. The mean annual WTP for haemodialysis for one's and altruistic haemodialysis was USD25,999.06 and USD 1539.89, respectively. Private hospital patients were likelier to pay for their haemodialysis (β = 0.39, 95%CI: 0.21 to 0.57, p < 0.001). Patients attending public-private partnership hospitals were less likely to pay for altruistic haemodialysis than those attending public hospitals (β = -1.65, 95%CI: -2.51 to -0.79, p < 0.001).

CONCLUSIONS

The willingness to pay for haemodialysis for themselves and others was high. The type of facility ESKD patients attended influenced their willingness to pay for haemodialysis. The findings highlight the need for policies to enhance affordable and equitable access to haemodialysis in Nigeria through pre-payment mechanisms and altruistic financing strategies.

Willingness to pay to enhance pandemic preparedness in Mauritius

OBJECTIVES

The objective of this study is to assess the determinants of willingness to pay to enhance pandemic preparedness in Mauritius.

STUDY DESIGN

A contingent valuation method is used to estimate willingness to pay to pay for enhancing pandemic preparedness using a sample of working people in Mauritius.

METHODS

A two-phase decision process analysis is carried out to model the willingness to pay to enhance pandemic preparedness. The first phase is to analyse the respondents' decision of whether or not to pay for enhancing pandemic preparedness using a Probit model. The second phase is to estimate the determinants of the amount of money respondents are willing to pay using a Tobit model.

RESULTS

Income earners are willing to pay an average of Rs. 1,900 (approximately USD 50) per annum to enhance pandemic preparedness. 'Perceived Response Efficacy', 'Awareness of the Need and Responsibility for Paying', 'Subjective Obligation to Pay' and the 'Theory of Planned Behaviour' are found to affect both stages of of the decision-making process. Knowledge on COVID-19 is found to have a positive impact on the decision to pay and health responsibility attitude is found to have a negative impact on the amount people are willing to pay.

CONCLUSIONS

On average, the government can potentially expect to mobilise an additional Rs. 1,047,470,000 (USD 27,565,000) from taxpayers to spend on enhancing pandemic preparedness in Mauritius. To increase willingness to pay for enhanced pandemic preparedness, the government can focus on improving knowledge on a pandemic, perceived response efficacy and awareness on need and responsibility of paying.

Evaluating the Economic Benefits of Tightening Regulations on the Use of Toluene, a Hazardous Chemical, in South Korea

The South Korean government currently designates toluene as a hazardous chemical, only limiting its use in products that are feared to be harmful. Since no measures to prohibit the use of toluene have been implemented, toluene is frequently detected in amounts that exceed the limit. Accordingly, the Government is considering implementing a plan to tighten the current regulations related to the use of toluene to prevent the occurrence of diseases caused by exposure and addiction to it. Therefore, the most important objective of this research is to evaluate quantitatively the economic benefits arising from the implementation of the plan in South Korea. To achieve the purpose of this paper, contingent valuation, an economic technique for analyzing data collected from a survey of people based on economic theory, is applied. For this purpose, a survey of 1000 people nationwide is conducted, and an analysis model that is well received in the literature is adopted. In other words, the annual willingness to pay (WTP) per household to strengthen the regulations to reduce the human health risks of toluene is evaluated to calculate its economic benefits. All the estimated WTP models secure statistical significance. The average WTP per household per annum is derived as KRW 3394 (USD 3.02). Considering that the country contained 20,573,060 households in 2021, the national economic benefits are calculated as KRW 69.82 billion (USD 62.23 million) every year. It is difficult to estimate accurately the costs incurred by tightening the regulations on toluene use, but they do not seem to exceed the benefits. Because tightening the regulations would be socially desirable, the Government would be justified in making this decision.

An Empirical Analysis of Income Elasticity of Out-of-Pocket Healthcare Expenditure in Mauritius

A free universal healthcare provision exists in Mauritius. Yet the share of out-of-pocket healthcare expenditure out of total household expenditure has been growing over time. This study estimates income elasticity of out-of-pocket healthcare expenditure using Mauritian household data within an Engel curve framework. In the absence of longitudinal data on out-of-pocket healthcare expenditure patterns, the study proposes the application of the pseudo-panel approach using cross-sectional Household Budget Survey waves from 1996/97 to 2017. Income elasticity of out-of-pocket healthcare expenditure is estimated to be 0.938, which is just below unity. This implies that out-of-pocket healthcare demand is not considered to be a luxury, but a necessity in Mauritius. In order to see the differences in income elasticities by income groups, separate regressions are estimated for each income quartile over different years. The results indicate that income elasticities of out-of-pocket healthcare expenditure vary non-monotonically.