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.

Noel Namuhani, Angela Kisakye, Suzanne N Kiwanuka
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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.
乌干达 Iganga 和 Mayuge 地区非正规部门工人对乌干达拟议国家医疗保险计划的支付意愿和认知能力:权变估值法。
背景 在大多数低收入国家,由于自付费用(OOP)高昂,获得医疗服务仍然是一项挑战,尤其是非正规部门的工人,乌干达的自付医疗费用超过 28.0%。为此,乌干达提出了一项国家医疗保险计划(NHI)。然而,乌干达尚未探讨非正规部门对拟议的国家医疗保险计划的支付意愿和能力。本研究评估了乌干达伊甘加和马尤格地区非正规部门工人对拟议的国家医疗保险计划的支付意愿和认知能力及其决定因素。方法 2019 年 4 月和 5 月在伊甘加和马尤格地区开展了一项横断面研究。采用竞标游戏技术的或有估价法征求支付意愿(WTP)。共随机抽取了 853 名非正规部门工作者,包括农民、商业驾驶员、渔民和商人。此外,还进行了七次焦点小组讨论 (FGD)。采用逻辑回归法来确定是否愿意为拟议的国民健康保险计划付费的决定因素。对定性数据进行了专题分析。结果 大多数受访者(695/853,81.5%)愿意为国家健康保险付费;WTP 中位数为每年 25,000 乌吉亚(6.8 美元);633/853(74.2%)的受访者认为他们有能力支付健康保险费用。支付意愿与渔民身份(AOR:1.70,95%CI:1.04-2.79,P = 0.035)、处于第四财富五分位数(AOR:2.98,95%CI:1.56-5.65)、未听说过医疗保险(AOR:0.50,95%CI:0.23-0.86,P = 0.032)和没有储蓄小组成员身份(AOR:0.51,95%CI:0.34-0.76,P<0.001)有显著关联。大多数参加 FGD 的人都愿意为拟议的计划付费;但是,由于他们的贫困程度较高且收入不稳定,有些人怀疑自己是否有能力为计划付费。结论 非正式部门的医疗保险支付意愿很高。因此,政府将国民健康保险推广到非正规部门是可行的。然而,在制定适当的保费时,应优先考虑提高认识和适当考虑高贫困水平。
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