Willingness to pay for private voluntary health insurance in southeast Nigeria

1
Willingness to pay for private voluntary health
insurance in southeast Nigeria

• Obinna Onwujekwea and Edit V. Velényib
• a Health policy Research Group/Department of
  Health Administration and Management, University
  of Nigeria, Enugu-Campus, Enugu
• b The World Bank, Washington DC.

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Rationale

• A real challenge of health care financing in
  Nigeria is the paucity of insurance mechanisms
  for financial risk protection.
• Public expenditures in Nigeria account for 20-30
  of total health expenditures whilst private
  expenditures accounts for 70-80 and the dominant
  private expenditure is out-of-pocket spending
  (OOPS) (Soyibo, 2004)
• The dominant reliance on OOPS and the
  considerable absence of risk sharing is largely
  responsible for catastrophic health expenditures

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Rationale CONTD

• The National Health Insurance Scheme (NHIS) was
  launched in 2005 but its coverage is limited to
  federal government civil servants.
• What happens to other people?
• The National Health Financing Policy provides for
  the use of private voluntary health insurance
  (PVHI) as one strategy for ensuring universal
  coverage with health insurance in the country
• It is important to understand the willingness of
  consumers to enroll and pay for PVHI for
  developing and implementing viable PVHI schemes

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Objectives

• To determine the willingness to enroll and to pay
  for PVHI
• To understand the determinants of willingness to
  enroll and WTP for PVHI

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Research Methods

• The study was conducted in an urban area and a
  rural area in Enugu State, located in southeast
  Nigeria
• Pre-tested interviewer administered questionnaire
  was used to collect data from a random sample of
  200 households from the rural and 250 households
  from the urban area

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Research Methods II

• The Contingent valuation method (CVM) was used to
  elicit willingness to pay (WTP) for PVHI using
  the bidding game question format.
• Before eliciting WTP, a scenario was presented to
  the respondents describing PVHI, its potential
  benefits, benefit package and payment vehicle.
• All the respondents were read an introductory
  explanation (in the local language) about PVHI
  and the CVM scenario.

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Data analysis

• The data was examined for links between
  socio-economic status (SES), geographic location
  and occupation with WTP and willingness to enroll
• Ordinary least squares (OLS) multiple regression
  analyses were undertaken to tests for theoretical
  (construct) validity of elicited WTP for PVHI

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Results

• Willingness to enroll and to pay for PVHI
• 380 (86.0) respondents were willing to
  personally enroll in PVHI and 377 (85.7) were
  willing to enroll other household members.
• 220 (52.1) respondents were willing to pay a
  monthly premium of 500 Naira (4.2) for
  themselves, whilst 98 (23.6) were willing to pay
  4.2 for other household members.
• 226 (53.2) were willing to contribute some money
  so that the poorest people in their communities
  would benefit from health insurance.

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Results II

• For the full sample of the respondents, the
  median monthly WTP for personal premium was 500
  Naira (4.2), whilst it was 200 Naira (1.7) per
  person for other household members.
• The median monthly altruistic WTP amount was 33.3
  Naira (0.3).
• The mean WTP for respondents and for other
  household members were 3.3 and 2.2 respectively
  for the full sample.
• For only the respondents that were willing to
  pay, the mean WTP for respondents and for other
  household members were (5.2) and (5.0)
  respectively.

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Results III

• Rural dwellers and worse-off socio-economic
  status (SES) groups stated smaller WTP than
  urbanites and better-off SES groups.

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Results III Geographic differences in
willingness to enroll and to pay for PVHI
Mean (SD) WTP self Median WTP self Mean (SD) WTP for other householders Median WTP for other householders
Urban 459.1 Naira (342.8) 500 Naira 292.4 Naira (265.3) 200 Naira
Rural 314.6 Naira (221.6) 200 Naira 218.7 Naira (215.7) 100 Naira
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SES differences in willingness to enroll and pay
for PVHI
Q1 Most poor n 109 Q2 Very poor n 109 Q3 poor n 109 Q4 Least poor n 109
Willing to enroll (self) n () 104(95.4) 99(90.8) 86(78.9) 88(80.7)
Willing to pay (self) n () 38 (34.9) 53(48.6) 58(53.2) 70(64.2)
Willing to enroll other householders n () 104(95.4) 97(89.0) 84(77.1) 89(81.7)
WTP for other householders n () 17 (15.6) 17(15.6) 28(25.7) 36(33.0)
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SES differences CONTD

• As SES increases so does the level of WTP to pay
  for PVHI (plt0.01).
• For only the positive WTP cases, the mean WTP for
  the respondents was 4.4, 5.1, 4.8 and 5.9 for
  Q1,Q2,Q3 and Q4
• For only the positive WTP cases, the mean WTP for
  the other household members was 4.6, 5.1, 4.8
  and 5.3 for Q1,Q2,Q3 and Q4

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Construct validity

• WTP was positively statistically significantly
  related to acceptability of health insurance and
  socio-economic status of the households (plt0.05).
  
• The regression models were statistically
  significant (plt0.01).

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Conclusion I

• PVHI is a promising strategy for health financing
  in southeast Nigeria
• Unsubsidized PVHI may never cover everybody
  especially indigents, but if it covers some of
  the people willing and able to pay such as the
  better-off SES classes, that is at least better
  than having them face high OOPS

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Acknowledgement

• We are grateful to The World Bank, Washington DC
  for funding the study.