Department of Economics, School of Policy & Global Affairs, City University of London, London, United Kingdom.
Department of Research, Office of Health Economics, London, United Kingdom.
PLoS One. 2023 Apr 13;18(4):e0281724. doi: 10.1371/journal.pone.0281724. eCollection 2023.
Lack of credibility and trust in fund managers has been highlighted as one of the key reasons why people do not join health insurance schemes in low- and middle-income countries, especially in Africa. This work investigates the impact of corruption on households' willingness to participate and pay for health insurance in Sierra Leone. A discrete choice experiment (DCE) method was used to elicit households' willingness to participate in a health insurance scheme with different attributes. The data were collected from 1458 representative households working in the informal sector of the Northern and Western regions. We explore the relationship between household characteristics and experienced (respectively, perceived) corruption with binary and ordered logit models. We use a Mixed Logit model to estimate the association between corruption and participation in a Health Insurance Scheme (HIS) and households' willingness to pay for a HIS. We find that corruption decreases participation in a public HIS and the willingness to pay for it. Our results highlight the perverse spillover effects of corruption. Not only does corruption hinder the effectiveness of healthcare systems and, thus, worsen health outcomes. It also undermines the willingness to pay for them, jeopardizing the sustainability of healthcare systems in the countries that need them most.
在中低收入国家，尤其是在非洲，基金经理缺乏公信力和信任已被认为是人们不加入健康保险计划的主要原因之一。本研究调查了腐败对塞拉利昂家庭参加和支付健康保险意愿的影响。采用离散选择实验（DCE）方法来了解家庭对不同属性的健康保险计划的参与意愿。数据来自北部和西部地区非正规部门的 1458 个代表性家庭。我们利用二元和有序逻辑回归模型探讨了家庭特征与经历（分别为感知）腐败之间的关系。我们使用混合 Logit 模型来估计腐败与参加健康保险计划（HIS）之间的关联以及家庭对 HIS 的支付意愿。我们发现腐败降低了对公共 HIS 的参与度和支付意愿。我们的研究结果突出了腐败的不良溢出效应。腐败不仅阻碍了医疗保健系统的有效性，从而恶化了健康结果，还削弱了对其支付意愿，危及了最需要这些系统的国家的医疗保健系统的可持续性。
