WILLINGNESS TO PAY FOR VOLUNTARY CONTRIBUTOR SOCIAL HEALTH INSURANCE AMONG RURAL DWELLERS IN ERUWA, OYO STATE IN NIGERIA

Abstract

The National Health Insurance Scheme (NHIS) was introduced in Nigeria to provide social protection and reduce health expenditures. Despite its promising objectives, the scheme is faced with challenges of poor coverage and unwillingness to participate and pay particularly among the informal sector. In Nigeria, there is paucity of information about the feasibility of voluntary health insurance and people's willingness to pay for it. This study was designed to identify the factors that influence willingness to pay for the Voluntary Contributor Social Health Insurance by rural dwellers in Eruwa, Oyo State. This descriptive cross-sectional study was carried out between September and November, 2014. Two hundred and sixteen out of 255 communities and 360 households out of 2160 households were selected using systematic random sampling from the six wards. Data were collected using a validated, pre-tested, interviewer-administered questionnaire to elicit information on socio-demographics, most recent types of sickness, payment coping mechanism, knowledge of health insurance and willingness to pay. Willingness to pay appraisal based on the Contingent Valuation Method was used to elicit the amount to be paid. Each respondent was presented with an initial bid amount of (N1500) and if the respondent accepts to pay this amount, the interviewer revises this amount upwards by N200 each time until a ceiling is reached where respondents were asked to state the maximum amount they were willing to pay. On the other hand, if the respondent refuses the initial bid of (1500), this is further lowered by N200 each time. A negative response will require the respondent to state the minimum amount he/she will be willing to pay. Data were analysed using descriptive statistics and probit regression. Age of respondents was 38.2±2.7 years with majority (94.7%) of the household heads being males and 82.6% were married. Trading (32.3%) was the commonest occupation and 51.4% attended at most secondary school education. Fever was the predominant complaint (35.5%) in the households in the past one month. Out-of-pocket payment constituted the mode of payment for treatment in 86.2% of participants. Most (71.3%) had not heard about health insurance and 77.2% of the household heads were willing to pay an average amount of N360 (range of N200-N500) per person per month. Financial constraint was the main reason why majority (60.5%) would not be willing to pay for health insurance. Household size, health status, living standard and food expenses significantly influenced their willingness to pay positively. There is high enthusiasm to pay for the voluntary contributor health insurance among rural dwellers; though, the agreed amount was low. It is therefore imperative for the government to provide subsidy to rural dwellers that may not be able to access health care services given their low level of income and vulnerability to diseases.