Factors associated with household willingness to pay for Universal Health Coverage in Cameroon: a nationwide cross-sectional analysis.
Humans
Cameroon
Cross-Sectional Studies
Female
Male
Universal Health Insurance
/ economics
Adult
Financing, Personal
/ statistics & numerical data
Middle Aged
Family Characteristics
Health Expenditures
/ statistics & numerical data
Surveys and Questionnaires
Socioeconomic Factors
Rural Population
/ statistics & numerical data
Cameroon
Factors
Universal Health Coverage
Willingness to pay
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
30 Oct 2024
30 Oct 2024
Historique:
received:
15
04
2023
accepted:
15
10
2024
medline:
31
10
2024
pubmed:
31
10
2024
entrez:
31
10
2024
Statut:
epublish
Résumé
Sustained financing for Universal Health Coverage (UHC) has been a concern for the Cameroon government. Household contributions have been considered as a financing mechanism, but this raises concerns on the willingness of households to pay for UHC. The current study assessed factors associated with the willingness to pay (WTP) for UHC in Cameroon. Community based, cross-sectional analysis of data from households (selected via multi-stage, randomized, cluster sampling) across all ten regions of Cameroon, during July 2020. Factors associated with WTP for UHC were determined using a multinominal logistic regression model, tested at varying significance levels (1%, 5%, and 10%) to enhance its ability to detect meaningful and practical value associations. Overall, 5,014 households were surveyed, 64.3% and 35.6% from rural and urban areas respectively. Household heads were 40.2 ± 10.1 years old and mostly male (60.6%). Most surveyed households (72%) were willing to contribute for UHC. Amongst these willing households, WTP varied with the sex (females opted for lower payments) and educational level (those with ≥ high school education opted for contributions ≥ US$ 165.6 annually, p < 0.01) of the household head. WTP also varied proportionally with household income and was influenced by the sector of activity (formal secondary/tertiary and informal sector workers opted for contributions > US$ 165.6 annually, p < 0.01) of the household head. Other factors affecting WTP included household size (households with ≥ 13 persons opted for contributions ≥ US$ 165.6, p < 0.01) and the age of the household head (those ≥ 55 years opted for higher contributions; US$ 33.1-82.6, p < 0.01). WTP varied positively with knowledge on UHC and affiliation to a health insurance scheme. Household who did not resort to self-medication/prayers when in need of healthcare services opted for higher contributions (US$ 82.6- 165.6, p < 0.01). UHC implementation in Cameroon will require that factors shown here-in to influence WTP be carefully considered. Modifiable factors such as self-medication/prayers and poor knowledge on UHC, underlines the need for greater sensitization on UHC. Given the high WTP from the informal sector, characterization of the sector could go a long way to increase the financial envelope allocated for UHC.
Sections du résumé
BACKGROUND
BACKGROUND
Sustained financing for Universal Health Coverage (UHC) has been a concern for the Cameroon government. Household contributions have been considered as a financing mechanism, but this raises concerns on the willingness of households to pay for UHC. The current study assessed factors associated with the willingness to pay (WTP) for UHC in Cameroon.
METHODS
METHODS
Community based, cross-sectional analysis of data from households (selected via multi-stage, randomized, cluster sampling) across all ten regions of Cameroon, during July 2020. Factors associated with WTP for UHC were determined using a multinominal logistic regression model, tested at varying significance levels (1%, 5%, and 10%) to enhance its ability to detect meaningful and practical value associations.
RESULTS
RESULTS
Overall, 5,014 households were surveyed, 64.3% and 35.6% from rural and urban areas respectively. Household heads were 40.2 ± 10.1 years old and mostly male (60.6%). Most surveyed households (72%) were willing to contribute for UHC. Amongst these willing households, WTP varied with the sex (females opted for lower payments) and educational level (those with ≥ high school education opted for contributions ≥ US$ 165.6 annually, p < 0.01) of the household head. WTP also varied proportionally with household income and was influenced by the sector of activity (formal secondary/tertiary and informal sector workers opted for contributions > US$ 165.6 annually, p < 0.01) of the household head. Other factors affecting WTP included household size (households with ≥ 13 persons opted for contributions ≥ US$ 165.6, p < 0.01) and the age of the household head (those ≥ 55 years opted for higher contributions; US$ 33.1-82.6, p < 0.01). WTP varied positively with knowledge on UHC and affiliation to a health insurance scheme. Household who did not resort to self-medication/prayers when in need of healthcare services opted for higher contributions (US$ 82.6- 165.6, p < 0.01).
CONCLUSION
CONCLUSIONS
UHC implementation in Cameroon will require that factors shown here-in to influence WTP be carefully considered. Modifiable factors such as self-medication/prayers and poor knowledge on UHC, underlines the need for greater sensitization on UHC. Given the high WTP from the informal sector, characterization of the sector could go a long way to increase the financial envelope allocated for UHC.
Identifiants
pubmed: 39478533
doi: 10.1186/s12913-024-11767-6
pii: 10.1186/s12913-024-11767-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1313Informations de copyright
© 2024. The Author(s).
Références
SDG Target 3. 8 | Achieve universal health coverage. UHC. Available from: https://www.who.int/data/gho/data/themes/theme-details/GHO/universal-health-coverage
World Health Organization (WHO). Universal Health Coverage [Internet]. [cited 2022 Dec 13]. https://www.who.int/health-topics/universal-health-coverage
Arrow KJ. Uncertainty and the welfare economics of medical care. 1963. Bull World Health Organ. 2004;82(2):141–9.
pubmed: 15042238
pmcid: 2585909
Njoumemi Z, Fadimatou A, Ntavoua SH, Mongbet O, Manouore R. Health Insurance Coverage and its socioeconomic and demographic determinants in Cameroon. Int J Health Econ Policy. 2023;8(2):44.
World health. statistics 2023 – Monitoring health for the SDGs. 2023.
Ntembe A, Tawah R, Faux E. Redistributive effects of health care out-of-pocket payments in Cameroon. Int J Equity Health. 2021;20(1):227.
doi: 10.1186/s12939-021-01562-8
pubmed: 34663342
pmcid: 8522243
Kalish S, Nelson P. A comparison of ranking, rating and Reservation Price Measurement in Conjoint Analysis. Mark Lett. 1991;2(4):327–35.
doi: 10.1007/BF00664219
Kohli R, Mahajan V. A reservation-price model for optimal pricing of Multiattribute Products in Conjoint Analysis. J Mark Res. 1991;28(3):347–54.
doi: 10.1177/002224379102800309
HAL, Gall-Ely ML. Définition, mesure et déterminants du consentement à payer du consommateur: synthèse critique et voies de recherche. 2009. (Post-Print).
Kibu OD, Kepgang E, Sinsai R, Conner A, Asahngwa C, Ngwa W, et al. Barriers and Motivations for Health Insurance Subscription among Health-Care Users in Cameroon. J Surg Res. 2024;293:158–67.
doi: 10.1016/j.jss.2023.09.010
pubmed: 37774593
Cheno RW, Tchabo W, Tchamy J. Willingness to join and pay for community-based health insurance and associated determinants among urban households of Cameroon: case of Douala and Yaounde. Heliyon. 2021;7(3):e06507.
doi: 10.1016/j.heliyon.2021.e06507
pubmed: 33817375
pmcid: 8010406
Moubé M. Des principes de responsabilité et de solidarité pour un accès équitable aux soins de santé: le cas des travailleurs de l’informel urbain du Cameroun en situation de vulnérabilité. 2016. Available from: https://papyrus.bib.umontreal.ca/xmlui/handle/1866/13557
Olsen R. Carol Sheets. Computer-Assisted Personal Interviewing (CAPI). In: Encyclopedia of Survey Research Methods [Internet]. 2455 Teller Road, Thousand Oaks California 91320 United States of America: Sage Publications, Inc.; 2008. Available from: https://methods.sagepub.com/reference/encyclopedia-of-survey-research-methods
Oraro T, Ngube N, Atohmbom GY, Srivastava S, Wyss K. The influence of gender and household headship on voluntary health insurance: the case of North-West Cameroon. Health Policy Plan. 2018;33(2):163–70.
doi: 10.1093/heapol/czx152
pubmed: 29145600
Gustafsson-Wright E, Asfaw A, van der Gaag J. Willingness to pay for health insurance: an analysis of the potential market for new low-cost health insurance products in Namibia. Soc Sci Med. 2009;69(9):1351–9.
doi: 10.1016/j.socscimed.2009.08.011
pubmed: 19765877
Dror DM, Radermacher R, Koren R. Willingness to pay for health insurance among rural and poor persons: field evidence from seven micro health insurance units in India. Health Policy. 2007;82(1):12–27.
doi: 10.1016/j.healthpol.2006.07.011
pubmed: 16971017
Institut National de la Statistique (INS) et ICF. Enquête Démographique et de Santé du Cameroun 2018. Yaoundé, Cameroun et Rockville. Maryland, USA: INS et ICF; 2020.
Milazzo A, van de Walle D. Women left behind? Poverty and Headship in Africa. Demography. 2017;54(3):1119–45.
doi: 10.1007/s13524-017-0561-7
pubmed: 28484997
Dixon J, Luginaah I, Mkandawire P. The National Health Insurance Scheme in Ghana’s Upper West Region: a gendered perspective of insurance acquisition in a resource-poor setting. Soc Sci Med. 2014;122:103–12.
doi: 10.1016/j.socscimed.2014.10.028
pubmed: 25441322
Mao Z. Farmer’s willingness to pay for cooperative medical system. Cambridge: Harvard; 2000.
N’Guessan CFJ. Le Consentement Des ménages Ruraux à payer une prime d’assurance maladie en Côte d’Ivoire. Revue d’économie Du développement. 2008;16(1):101–24.
doi: 10.3917/edd.221.0101
Ahmed S, Hoque ME, Sarker AR, Sultana M, Islam Z, Gazi R, et al. Willingness-to-pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh. PLoS ONE. 2016;11(2):e0148211.
doi: 10.1371/journal.pone.0148211
pubmed: 26828935
pmcid: 4734618
Seck I, Dia AT, Sagna O, Leye MM. Déterminants De l’adhésion et de la fidélisation aux mutuelles de santé dans la région de Ziguinchor (Sénégal). Santé Publique. 2017;29(1):105–14.
doi: 10.3917/spub.171.0105
pubmed: 28737317
Cochrane JH. Time-consistent Health insurance. J Polit Econ. 1995;103(3):445–73.
doi: 10.1086/261991
Chambaretaud S, Hartmann L. Économie De La santé: avancées théoriques et opérationnelles. Revue De l’OFCE. 2004;91(4):235–68.
Entele BR, Emodi NV. Health Insurance Technology in Ethiopia: willingness to pay and its implication for Health Care Financing. Am J Public Health Res. 2016;4(3):98–106.
Criel B, Waelkens MP. Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong? Soc Sci Med. 2003;57(7):1205–19.
doi: 10.1016/S0277-9536(02)00495-1
pubmed: 12899905