Willingness and Perceived ability to pay for Uganda’s Proposed National Health Insurance Scheme among Informal Sector workers in Iganga and Mayuge districts, Uganda: A Contingent Valuation Method.

Abstract

Background Access to health care remains a challenge, especially among the informal sector workers in most low-income countries, due to high out-of-pocket (OOP) expenditures, with Uganda spending over 28.0% out of pocket on health care. In response, Uganda has proposed a national health insurance scheme (NHI). However, the willingness and ability to pay for the proposed NHI scheme within the informal sector have not yet been explored in Uganda. This study assessed the willingness and perceived ability to pay for the proposed NHI scheme and its determinants among the informal sector workers in Iganga and Mayuge districts, Uganda. Methodology A cross-sectional study was conducted in Iganga and Mayuge districts in April and May 2019. A contingent valuation method using the bidding game technique was used to elicit the willingness to pay (WTP). A total of 853 informal sector workers, including farmers, commercial motorists, fishermen, and traders, were randomly sampled. Seven focus group discussions (FGD) were also conducted. Logistic regression was done to identify the determinants of willingness to pay for the proposed NHI scheme. Qualitative data was analyzed thematically. Results The majority 695/853, (81.5%) of the respondents were willing to pay for NHI; the median WTP was UGX 25,000 (USD 6.8) annually; and 633/853, (74.2%) of the respondents believed that they were able to pay for the health insurance. Willingness to Pay was significantly associated with being a fisher folk (AOR: 1.70 95%CI: 1.04-2.79, P = 0.035), being in the fourth wealth quintile (AOR: 2.98, 95% CI: 1.56–5.65), not hearing about health insurance (AOR: 0.50 95%CI: 0.23-0.86, P = 0.032), and not having saving group membership (AOR: 0.51, 95%CI: 0.34-0.76, P<0.001). Most of the FGD participants were willing to pay for the proposed scheme; however, some of the participants doubted their ability to pay for the scheme given their high poverty levels and their unstable income. Conclusion The willingness to pay for health insurance in the informal sector is high. Therefore, it is viable for the government to extend NHI to the informal sector. However, awareness building and due consideration of high poverty levels in setting appropriate premiums should be a priority.