Willingness to pay for rural health insurance : evidence from three African countries
The vast majority of Africans living in rural areas do not have access to health insurance and policy related questions to assist health planners design and implement financially viable rural health insurance schemes have yet to be fully addressed. This thesis seeks to fill some existing gaps in the knowledge about the performance of existing schemes and methods of assessing "willingness to pay" (WTP) and financial feasibility. It begins with a review of the literature on the theory of insurance and its practice in rural areas in Sub-Saharan Africa, that contributed to the research conceptual framework and implementation. Two health insurance schemes (La Carte d'Assurance Maladie and the Abota in Burundi and Guinea Bissau), were evaluated regarding their social and financial performance in rural areas. The research instruments were household surveys, focus group discussions and health facility costing. In both schemes access to health care appeared to have improved and the findings suggested that were quality of care improved, the schemes would considerably reduce financial concerns faced by people at the time of illness. They would also raise significant revenue. In the third study country, Ghana, a study of preferred benefit options, WTP, and community rated premiums for a proposed health insurance scheme was undertaken in a rural area. In undertaking this feasibility study, the research developed a WTP instrument and used a contingent valuation approach. Eight hundred households participated in the study. Eighty percent of households said they would be willing to pay the premium required to recover 100% of the non-salary recurrent costs of providing OPD care in a local clinic and inpatient care in a hospital. The stated WTP was conditional on; a) the insurance scheme giving access to health care in which drugs and basic laboratory investigations would be available, b) health staff being professionally qualified and respectful, and c) a local solidarity association having a role in administering the participating health facilities. Econometric analysis of households' WTP for outpatient insurance cover supported the hypothesis that WTP is influenced by a) the experience of frequent difficulties in paying for health care in the past; b) the perception that adults in the household are healthier than those in other households; and c) the household head's sex, education and religion.