Department of Health Administration, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.
Department of Health Administration and Management; Department of Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.
Niger J Clin Pract. 2023 Jul;26(7):908-920. doi: 10.4103/njcp.njcp_612_22.
Over 70% of Nigeria's population is poor and rural, and most lack financial risk protection against ill health. Community-based health insurance (CBHI) may be an essential intervention strategy for ensuring that quality healthcare reaches the informal and rural populations.
This article explores the willingness to enroll (WTE) and willingness to pay (WTP) for CBHI by community members, their decision considerations, and associated factors in Enugu State, Nigeria.
We adopted a cross-sectional survey design with a multi-stage sampling approach. A validated and pre-tested questionnaire was used to elicit information from the respondents. WTE and WTP for CBHI was determined using the bid contingent valuation method. A test of correlation/association (Chi-square and ordinary least square regression) was conducted to ascertain the relationship between WTP for CBHI and other variables at a 95% confidence interval. The socioeconomic status index was generated using principal component analysis. A test of association was conducted between the demographic characteristics and WTE and WTP variables.
A total of 501 household heads or their representatives were included in the study which yielded a return rate of 98.2%. The finding showed that most (92.4%) of the respondents indicated a WTE in CBHI. 86.6% indicated a willingness to pay cash for CBHI, while 84.4% indicated a willingness to pay other household members for CBHI. There was a significant association between gender, marital status, education, location, and willingness to pay. The study shows that 81.6% of the respondent stated that qualified staff availability motivates their WTE/WTP for CBHI, while 78.1% would be willing to enroll and pay for CBHI if services were provided free, and 324 (74.6%) stated that proximity to a health facility would encourage them to enroll and pay for the CBHI.
This community demand analysis shows that rural and peri-urban community members are open to using a contributory mechanism for their health care, raising the prospect of establishing CBHI. To achieve universal health coverage, policy measures need to be taken to promote participation, provide financial and non-financial incentives and ensure that the service delivery mechanism is affordable and accessible. Further studies are needed to explore ways to encourage participation and enrollment in CBHI and other contributory schemes among under-served populations and improve access to and utilization of healthcare services.
尼日利亚超过 70%的人口生活在贫困和农村地区，大多数人缺乏应对健康不良的财务风险保护。社区为基础的健康保险（CBHI）可能是确保非正式和农村人口获得优质医疗保健的重要干预策略。
本文探讨了尼日利亚埃努古州社区成员对 CBHI 的参保意愿（WTE）和支付意愿（WTP）、他们的决策考虑因素以及相关因素。
我们采用了横断面调查设计和多阶段抽样方法。使用经过验证和预测试的问卷从受访者那里收集信息。使用投标条件价值评估法确定 CBHI 的 WTE 和 WTP。使用卡方检验和普通最小二乘回归进行相关性/关联性检验，以确定 CBHI 的支付意愿与其他变量之间的关系，置信区间为 95%。使用主成分分析生成社会经济地位指数。进行了关联检验，以确定人口统计学特征与 WTE 和 WTP 变量之间的关系。
共有 501 户户主或其代表参加了这项研究，回收率为 98.2%。调查结果表明，大多数（92.4%）受访者表示愿意参加 CBHI。86.6%的人表示愿意为 CBHI 支付现金，84.4%的人表示愿意为 CBHI 支付其他家庭成员的费用。性别、婚姻状况、教育程度、地点与支付意愿之间存在显著关联。研究表明，81.6%的受访者表示合格员工的可用性是他们对 CBHI 的 WTE/WTP 的动机，而 78.1%的受访者愿意在免费提供服务的情况下参保并支付 CBHI，324 名受访者（74.6%）表示靠近医疗机构将鼓励他们参保并支付 CBHI。
这项社区需求分析表明，农村和城乡结合部社区成员愿意使用缴费机制来支付他们的医疗费用，这为建立 CBHI 提供了前景。为了实现全民健康覆盖，需要采取政策措施来促进参保，提供财务和非财务激励，并确保服务提供机制是负担得起和可及的。还需要进一步研究如何鼓励服务不足人群参与 CBHI 和其他缴费计划并改善他们对医疗保健服务的利用。
