Kalyango Edward, Kananura Rornald Muhumuza, Kiracho Elizabeth Ekirapa
Department of Health Policy and Planning, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of international Development, The London School of Economics and Political Science, London, UK.
Cost Eff Resour Alloc. 2021 Apr 20;19(1):21. doi: 10.1186/s12962-021-00274-8.
Uganda is in discussions to introduce a national health insurance scheme. However, there is a paucity of information on household preferences and willingness to pay for health insurance attributes that may guide the design of an acceptable health insurance scheme. Our study sought to assess household preferences and willingness to pay for health insurance in Kampala city using a discrete choice experiment.
This study was conducted from 16th February 2020 to 10th April 2020 on 240 households in the Kawempe division of Kampala city stratified into slum and non-slum communities in order to get a representative sample of the area. We purposively selected the communities that represented slum and non-slum communities and thereafter applied systematic sampling in the selection of the households that participated in the study from each of the communities. Four household and policy-relevant attributes were used in the experimental design of the study. Each respondent attended to 9 binary choice sets of health insurance plans that included one fixed choice set. Data were analyzed using mixed logit models.
Households in both the non-slum and slum communities had a high preference for health insurance plans that included both private and public health care providers as compared to plans that included public health care providers only (non-slum coefficient β = 0.81, P < 0.05; slum β = 0.87, p < 0.05) and; health insurance plans that covered extended family members as compared to plans that had limitations on the number of family members allowed (non-slum β = 0.44, P < 0.05; slum β = 0.36, p < 0.05). Households in non-slum communities, in particular, had a high preference for health insurance plans that covered chronic illnesses and major surgeries to other plans (0.97 β, P < 0.05). Our findings suggest that location of the household influences willingness to pay with households from non-slum communities willing to pay more for the preferred attributes.
Potential health insurance schemes should consider including both private and public health care providers and allow more household members to be enrolled in both slum and non-slum communities. However, the inclusion of more HH members should be weighed against the possible depletion of resources and other attributes. Potential health insurance schemes should also prioritize coverage for chronic illnesses and major surgeries in non-slum communities, in particular, to make the scheme attractive and acceptable for these communities.
乌干达正在商讨引入一项国家医疗保险计划。然而，关于家庭偏好以及为医疗保险属性支付意愿的信息匮乏，而这些信息可能会指导设计出一项可接受的医疗保险计划。我们的研究旨在通过离散选择实验评估坎帕拉市家庭对医疗保险的偏好和支付意愿。
本研究于2020年2月16日至2020年4月10日在坎帕拉市卡韦姆佩分区的240户家庭中进行，这些家庭被分为贫民窟和非贫民窟社区，以便获得该地区具有代表性的样本。我们有目的地选择了代表贫民窟和非贫民窟社区的群体，然后在每个社区中采用系统抽样的方法选择参与研究的家庭。在本研究的实验设计中使用了四个与家庭和政策相关的属性。每位受访者要面对9组医疗保险计划的二元选择，其中包括一组固定选择。数据使用混合逻辑模型进行分析。
与仅包括公共医疗服务提供者的计划相比，非贫民窟和贫民窟社区的家庭对既包括私立又包括公共医疗服务提供者的医疗保险计划有更高的偏好（非贫民窟系数β = 0.81，P < 0.05；贫民窟β = 0.87，p < 0.05）；与对允许的家庭成员数量有限制的计划相比，覆盖大家庭成员的医疗保险计划更受青睐（非贫民窟β = 0.44，P < 0.05；贫民窟β = 0.36，p < 0.05）。特别是，非贫民窟社区的家庭对涵盖慢性病和重大手术的医疗保险计划的偏好高于其他计划（β = 0.97，P < 0.05）。我们的研究结果表明，家庭所在地会影响支付意愿，非贫民窟社区的家庭愿意为其偏好的属性支付更多费用。
潜在的医疗保险计划应考虑纳入私立和公共医疗服务提供者，并允许更多家庭成员在贫民窟和非贫民窟社区参保。然而，纳入更多家庭成员应权衡可能导致的资源耗尽和其他属性。潜在的医疗保险计划还应特别优先考虑非贫民窟社区的慢性病和重大手术的覆盖范围，以使该计划对这些社区具有吸引力并被接受。
