Faculty of Management and Economic Sciences, University of Yaoundé 2, P.O BOX 1365, Yaoundé, Cameroon.
Department of studies and projects, Ministry of Public Health, Yaoundé, Cameroon.
BMC Health Serv Res. 2024 Oct 30;24(1):1313. doi: 10.1186/s12913-024-11767-6.
Sustained financing for Universal Health Coverage (UHC) has been a concern for the Cameroon government. Household contributions have been considered as a financing mechanism, but this raises concerns on the willingness of households to pay for UHC. The current study assessed factors associated with the willingness to pay (WTP) for UHC in Cameroon.
Community based, cross-sectional analysis of data from households (selected via multi-stage, randomized, cluster sampling) across all ten regions of Cameroon, during July 2020. Factors associated with WTP for UHC were determined using a multinominal logistic regression model, tested at varying significance levels (1%, 5%, and 10%) to enhance its ability to detect meaningful and practical value associations.
Overall, 5,014 households were surveyed, 64.3% and 35.6% from rural and urban areas respectively. Household heads were 40.2 ± 10.1 years old and mostly male (60.6%). Most surveyed households (72%) were willing to contribute for UHC. Amongst these willing households, WTP varied with the sex (females opted for lower payments) and educational level (those with ≥ high school education opted for contributions ≥ US$ 165.6 annually, p < 0.01) of the household head. WTP also varied proportionally with household income and was influenced by the sector of activity (formal secondary/tertiary and informal sector workers opted for contributions > US$ 165.6 annually, p < 0.01) of the household head. Other factors affecting WTP included household size (households with ≥ 13 persons opted for contributions ≥ US$ 165.6, p < 0.01) and the age of the household head (those ≥ 55 years opted for higher contributions; US$ 33.1-82.6, p < 0.01). WTP varied positively with knowledge on UHC and affiliation to a health insurance scheme. Household who did not resort to self-medication/prayers when in need of healthcare services opted for higher contributions (US$ 82.6- 165.6, p < 0.01).
UHC implementation in Cameroon will require that factors shown here-in to influence WTP be carefully considered. Modifiable factors such as self-medication/prayers and poor knowledge on UHC, underlines the need for greater sensitization on UHC. Given the high WTP from the informal sector, characterization of the sector could go a long way to increase the financial envelope allocated for UHC.
持续为全民健康覆盖（UHC）提供资金一直是喀麦隆政府关注的问题。家庭缴费被认为是一种融资机制，但这引起了人们对家庭为 UHC 付费意愿的担忧。本研究评估了与喀麦隆支付意愿（WTP）相关的因素。
2020 年 7 月，在喀麦隆所有 10 个地区，通过多阶段、随机、聚类抽样选择家庭（通过多阶段、随机、聚类抽样选择）进行基于社区的横断面分析。使用多项逻辑回归模型确定与 UHC 支付意愿相关的因素，并在不同的显着性水平（1%、5%和 10%）下进行测试，以提高其检测有意义和实用价值关联的能力。
总体而言，调查了 5014 户家庭，其中 64.3%和 35.6%分别来自农村和城市地区。家庭户主年龄为 40.2±10.1 岁，主要为男性（60.6%）。大多数接受调查的家庭（72%）愿意为 UHC 做出贡献。在这些有意愿的家庭中，WTP 因性别（女性选择较低的支付额）和户主的教育程度（接受过≥高中教育的人选择每年支付≥165.6 美元，p<0.01）而有所不同。WTP 还与家庭收入成正比，并受户主活动部门（正规中学/高等教育和非正规部门工人选择每年支付>165.6 美元，p<0.01）的影响。影响 WTP 的其他因素包括家庭规模（≥13 人的家庭选择支付≥165.6 美元，p<0.01）和户主年龄（≥55 岁的人选择更高的支付额；33.1-82.6 美元，p<0.01）。WTP 与对 UHC 的知识和对健康保险计划的隶属关系呈正相关。当需要医疗服务时，不自行用药/祈祷的家庭选择更高的缴费额（82.6-165.6 美元，p<0.01）。
在喀麦隆实施 UHC 将需要仔细考虑这里显示的影响 WTP 的因素。可改变的因素，如自我用药/祈祷和对 UHC 的知识不足，强调了加强对 UHC 的宣传的必要性。鉴于非正规部门的高 WTP，对该部门进行特征描述可以大大增加为 UHC 分配的财务预算。
