Department of Health Financing, Health Strategy & Delivery Foundation (HSDF), Abuja, Nigeria.
Department of Planning Research & Statistics, Ministry of Health, Kaduna, Nigeria.
PLoS One. 2019 Aug 2;14(8):e0220558. doi: 10.1371/journal.pone.0220558. eCollection 2019.
Many low and middle-income countries are increasingly cognisant of the need to offer financial protection to its citizens through pre-payment schemes in order to curb high out of pocket expenditure and catastrophic spending on healthcare. However, there is limited rigorous contextual evidence to make decisions regarding optimal design of such schemes. This study assesses the willingness-to-pay (WTP) for the recently introduced state contributory health insurance scheme (SHIS) in Nigeria.
The study took place in 6 local government areas in Kaduna state, North-west Nigeria. Data were collected from a household survey using a three-stage cluster sampling approach, with each household having the same probability of being selected. Interviews were conducted with 4000 individuals in 1020 households. Contingent valuation was used to elicit the willing to pay (WTP) for the household using the bidding game technique. The relationship between socioeconomic status and WTP was also examined using logistic regression models.
About 82% of the household heads were willing to pay insurance premiums for their households, which came to an average of 513 Naira (1.68 USD) per month per person. The average amount individuals were willing to pay was lower in rural areas (611 Naira) compared to urban areas (463 Naira). These results were influenced by household size, level of education, occupation and household income. In addition, only 65% of the households had the ability to pay the average premium.
Socioeconomic factors influence individuals' WTP for contributory health insurance schemes. It is important to create awareness about the benefits of the insurance scheme, especially in rural areas, and in both the formal and informal sectors in Nigeria. WTP information can inform the amount of insurance premiums. However, it is important to consider differences between the WTP and the cost of benefits package to be offered, as the premium amount may need to be subsidized with public financing.
许多中低收入国家越来越意识到，需要通过预付款计划为其公民提供经济保障，以遏制医疗保健方面过高的自付支出和灾难性支出。然而，关于此类计划的最佳设计，仅有有限的严格背景证据可供决策参考。本研究评估了尼日利亚最近推出的国家缴费健康保险计划（SHIS）的支付意愿（WTP）。
本研究在尼日利亚西北部卡杜纳州的 6 个地方政府区进行。数据通过三阶段聚类抽样方法从家庭调查中收集，每个家庭被选中的概率相同。在 1020 户家庭中的 4000 个人进行了访谈。使用投标博弈技术，通过条件价值评估来了解家庭的支付意愿（WTP）。还使用逻辑回归模型检查了社会经济地位与 WTP 之间的关系。
约 82%的户主愿意为其家庭支付保险费，平均每人每月为 513 奈拉（1.68 美元）。农村地区（611 奈拉）个人愿意支付的平均金额低于城市地区（463 奈拉）。这些结果受到家庭规模、教育水平、职业和家庭收入的影响。此外，只有 65%的家庭有能力支付平均保费。
社会经济因素影响个人对缴费健康保险计划的支付意愿。重要的是要提高对保险计划的认识，特别是在农村地区，以及在尼日利亚的正规和非正规部门。支付意愿信息可以为保险费提供信息。但是，重要的是要考虑支付意愿和要提供的福利套餐的成本之间的差异，因为保费金额可能需要用公共资金来补贴。
