Djahini-Afawoubo Dosse Mawussi, Atake Esso-Hanam
Department of Economic Sciences, University of Lomé (Togo), Lome, West africa, Togo.
Health Econ Rev. 2018 Sep 17;8(1):22. doi: 10.1186/s13561-018-0208-4.
About 90.4% of Togolese workers operate in the informal sector and account for between 20 and 30% of Togo's Gross Domestic Product. Despite their importance in the Togolese economy, informal sector workers (ISW) do not have a health insurance scheme. This paper aims to estimate the willingness-to-pay (WTP) of ISW in order to have access to Mandatory Health Insurance (MHI), and to analyze the main determinants of WTP.
This study used data from the Community-Based Monitoring System (CBMS) project implemented in 2015 by the Partnership for Economic Policy (PEP). It focusses on 4,296 ISW (2,374 in urban areas and 1,922 in rural areas, respectively). The contingent valuation method was used to determine the WTP for the MHI while the Tobit model is used to analyze its determinants.
Findings indicate that about 92% of ISW agreed to have access to MHI, like for formal sector workers. Overall, ISW are willing to pay 2,569 FCFA (USD 4.7) per month. ISW in the poorest quintiles are willing to allocate a higher proportion of their income (15%) to the premium than the richest quintiles (2.5%). Generally, women are more interested in MHI than men, although men are willing to pay higher premiums (3,168.9 FCFA or USD 5.8) than women (2,077 FCFA or USD 3.8). Women's lower WTP can be explained by their low levels of education and income, and a lack of employment opportunities compared to men. The gender of the head of the household, the size of the household and the education and income levels are the main determinants of WTP.
We conclude that it is possible to extend MHI to ISW as long as their premiums are subsidized. The annual subsidy is estimated at 4.1% of the state current general budget or 96% of the health sector budget. In setting the premium, policy makers should take into account the MHI benefits package, subsidies from the government, and information about the WTP. It is important to emphasize that resource mobilization and management, as well as health services delivery, would be effective only in a context of improved governance.
多哥约90.4%的工人在非正规部门工作，占多哥国内生产总值的20%至30%。尽管非正规部门工人在多哥经济中很重要，但他们没有医疗保险计划。本文旨在估计非正规部门工人为获得强制医疗保险（MHI）的支付意愿（WTP），并分析支付意愿的主要决定因素。
本研究使用了经济政策伙伴关系（PEP）2015年实施的基于社区的监测系统（CBMS）项目的数据。它关注4296名非正规部门工人（分别为2374名城市工人和1922名农村工人）。采用条件估值法确定对强制医疗保险的支付意愿，同时使用托比特模型分析其决定因素。
研究结果表明，约92%的非正规部门工人同意像正规部门工人一样获得强制医疗保险。总体而言，非正规部门工人愿意每月支付2569非洲法郎（4.7美元）。最贫困五分之一的非正规部门工人愿意将其收入的更高比例（15%）用于支付保费，而最富有的五分之一（2.5%）则不然。一般来说，女性对强制医疗保险比男性更感兴趣，尽管男性愿意支付的保费（3168.9非洲法郎或5.8美元）高于女性（2077非洲法郎或3.8美元）。女性较低的支付意愿可以用她们较低的教育水平和收入以及与男性相比缺乏就业机会来解释。户主的性别、家庭规模以及教育和收入水平是支付意愿的主要决定因素。
我们得出结论，只要补贴非正规部门工人的保费，就有可能将强制医疗保险扩展到他们。年度补贴估计占国家当前一般预算的4.1%或卫生部门预算的96%。在设定保费时，政策制定者应考虑强制医疗保险福利套餐、政府补贴以及支付意愿信息。必须强调的是，只有在改善治理的背景下，资源调动和管理以及卫生服务提供才会有效。
