Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu-Campus, PMB 01129 UNTH Enugu, Nigeria.
Health Policy Plan. 2010 Mar;25(2):155-61. doi: 10.1093/heapol/czp046. Epub 2009 Oct 26.
OBJECTIVE: We examine socio-economic status (SES) and geographic differences in willingness of respondents to pay for community-based health insurance (CBHI). METHODS: The study took place in Anambra and Enugu states, south-east Nigeria. It involved a rural, an urban and a semi-urban community in each of the two states. A pre-tested interviewer-administered questionnaire was used to collect information from a total of 3070 households selected by simple random sampling. Contingent valuation was used to elicit willingness to pay (WTP) using the bidding game format. Data were examined for correlation between SES and geographic locations with WTP. Log ordinary least squares (OLS) was used to examine the construct validity of elicited WTP. RESULTS: Generally, less than 40% of the respondents were willing to pay for CBHI membership for themselves or other household members. The proportions of people who were willing to pay were much lower in the rural communities, at less than 7%. The average that respondents were willing to pay as a monthly premium for themselves ranged from 250 Naira (US$1.7) in a rural community to 343 Naira (US$2.9) in an urban community. The higher the SES group, the higher the stated WTP amount. Similarly, the urbanites stated higher WTP compared with peri-urban and rural dwellers. Males and people with more education stated higher WTP values than females and those with less education. Log OLS also showed that previously paying out-of-pocket for health care was negatively related to WTP. Previously paying for health care using any health insurance mechanism was positively related to WTP. CONCLUSION: Economic status and place of residence amongst other factors matter in peoples' WTP for CBHI membership. Consumer awareness has to be created about the benefits of CBHI, especially in rural areas, and the amount to be paid has to be augmented with other means of financing (e.g. government and/or donor subsidies) to ensure success and sustainability of CBHI schemes.
目的:我们考察了社会经济地位(SES)和地理位置对受访者对社区为基础的健康保险(CBHI)付费意愿的差异。
方法:该研究在尼日利亚东南部的阿南布拉州和埃努古州进行。它涉及每个州的一个农村、一个城市和一个半城市社区。使用经过预测试的访谈者管理问卷,通过简单随机抽样从总共 3070 户家庭中收集信息。使用投标游戏格式进行意愿支付(WTP)的条件价值评估。数据检查 SES 和地理位置与 WTP 之间的相关性。对数普通最小二乘法(OLS)用于检验得出的 WTP 的结构有效性。
结果:总体而言,不到 40%的受访者愿意为自己或其他家庭成员支付 CBHI 会员费。农村社区的支付意愿比例要低得多,不到 7%。受访者愿意为自己支付的月保费平均从农村社区的 250 奈拉(1.7 美元)到城市社区的 343 奈拉(2.9 美元)不等。SES 组越高,表明的 WTP 金额越高。同样,城市居民比城市周边和农村居民表示更高的 WTP。男性和受过更多教育的人比女性和受教育程度较低的人表示更高的 WTP 值。OLS 还表明,以前自费支付医疗费用与 WTP 呈负相关。以前使用任何医疗保险机制支付医疗费用与 WTP 呈正相关。
结论:经济地位和居住地等因素对人们对 CBHI 会员资格的 WTP 有影响。必须提高人们对 CBHI 的好处的认识,特别是在农村地区,并且必须通过其他融资方式(例如政府和/或捐助者补贴)来增加要支付的金额,以确保 CBHI 计划的成功和可持续性。
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