Patient’s willingness to pay for improved community health insurance in Tanzania

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES Health Policy Open Pub Date : 2024-09-29 DOI:10.1016/j.hpopen.2024.100130
Kassimu Tani , Brianna Osetinsky , Sally Mtenga , Günther Fink , Fabrizio Tediosi
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Abstract

Globally, achieving universal health coverage remains significant challenge. Health insurance coverage in low- and middle-income countries is still low with only a few African countries managed to reach 50% coverage. This study aimed to investigate the factors influencing patients’ willingness to pay (WTP) for medication and various versions of the improved Community Health Insurance Fund (iCHF) in Tanzania. A facility-based cross-sectional study was conducted in all hospitals, health centres, and eight randomly sampled dispensaries, sampling participant from the queue, one out of every three patient based on their order of entry into consultation room, and interviewed 1,748 patients in Kilombero and Same districts in Tanzania. We used multi-stage Contingent Valuation Methods exploring data collected during client exit interviews. We employed a random utility model and estimated WTP through an ordered logit model. The independent variables were; patient’s gender, age, marital status, education, employment status, Non-Communicable Disease (NCD) status, health insurance status, and the type of healthcare facility level. Our findings revealed that most patients exhibited a WTP of an amount equivalent to the current iCHF premiums and would also be willing to pay for an augmented iCHF premium inclusive of additional medication coverage. Upon adjusting for demographic characteristics, we observed that patients enrolled in an insurance program or benefiting from user fee waivers demonstrated a lower WTP for medication, while those with non-communicable diseases (NCDs) and seeking care in private facilities exhibited a higher WTP. Furthermore, patients with a secondary education level or above generally displayed higher WTP for premiums. Conversely, patients enrolled in private insurance and availing user fee waivers, along with those accessing care in public facilities, demonstrated a lowered WTP for iCHF premiums. These results highlight the need for targeted interventions to address systemic deficiencies and improve access to medicines. Our conclusions is that policies considering NCD status, education levels and income status are important when designing health insurance schemes for the informal sector in Tanzania, with the goal of increasing uptake of CHF.
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坦桑尼亚患者对改进社区医疗保险的支付意愿
在全球范围内,实现全民医保仍是一项重大挑战。中低收入国家的医疗保险覆盖率仍然很低,只有少数非洲国家的覆盖率达到了 50%。本研究旨在调查影响坦桑尼亚患者药物支付意愿(WTP)的因素以及各种版本的改进型社区医疗保险基金(iCHF)。我们在坦桑尼亚基隆贝罗区和萨姆区的所有医院、保健中心和随机抽取的 8 家药房开展了一项基于设施的横断面研究,根据患者进入诊室的顺序,每 3 位患者中抽取 1 位排队患者,对 1748 位患者进行了访谈。我们采用多阶段权变估值法对客户退出访谈时收集的数据进行了探讨。我们采用了随机效用模型,并通过有序对数模型估算了 WTP。自变量包括:患者的性别、年龄、婚姻状况、教育程度、就业状况、非传染性疾病(NCD)状况、医疗保险状况以及医疗机构级别类型。我们的研究结果表明,大多数患者的 WTP 金额相当于目前的临时医保基金保费,并且愿意支付包括额外药物保障在内的额外临时医保基金保费。在对人口特征进行调整后,我们发现,参加保险计划或享受使用费减免的患者对药物的购买意愿较低,而患有非传染性疾病(NCDs)和在私人机构就医的患者对药物的购买意愿较高。此外,具有中学或以上教育水平的患者一般表现出较高的保费 WTP。相反,参加私人保险和享受使用费减免的患者,以及在公共设施就医的患者,对非物质文化遗产保费的购买意愿较低。这些结果突出表明,有必要采取有针对性的干预措施,以解决系统性缺陷并改善药品的可及性。我们的结论是,在为坦桑尼亚非正规部门设计医疗保险计划时,考虑非传染性疾病状况、教育水平和收入状况的政策非常重要,其目标是提高对慢性阻塞性肺病的使用率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health Policy Open
Health Policy Open Medicine-Health Policy
CiteScore
3.80
自引率
0.00%
发文量
21
审稿时长
40 weeks
期刊最新文献
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