# WILLINGNESS TO PAY FOR VOLUNTARY HEALTH INSURANCE IN TANZANIA

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3 56 Ea s t Af r i c a n Me d i c a l Jo u r n a l February 2011 insurance and willingness to cross-subsidise the poor and household wealth and place of residence (urban/rural). Statistical significance was examined using Pearson chi-square (for binary or categorical variables) and the Mann-Whitney U test for continuous variables. In estimating determinants of actual WTP and willingness to cross-subsidise exploration of multiple models (two part model, the tobit model and the heckman - sample selection model) was done. The two part model performed best and is presented here. Hence, a logit model was used to assess the determinants of WTJ community health insurance and willingness to cross-subsidise the poor and an Ordinary Least Squares (OLS) log linear model was used to assess the determinants of the amounts people were WTP for insurance in urban areas, and the amounts people were willing to cross-subsidise in both rural and urban areas. These models were used to examine theoretical validity which assesses the extent to which the results are consistent with the following a priori expectations (Equation 1) (14). We hypothesised that willingness to pay would be affected by socio-demographic variables. Other variables which could affect WTP include: number of elderly in the household, previous care seeking behaviour and eligibility for exemptions (Table 3). We also included the type of insurance scheme as a variable in the cross-subsidisation model to assess whether members of the NHIF were more or less willing to cross-subsidise compared to CHF members. Equation 1: Empirical Model of WTJ/WTP for Health Insurance WTP= α + β 1 X 1 + β 2 X β n-1 X n-1 + β n X n 1 The dependant variable for the logit model was binary (1= willing to join insurance scheme/willingness to cross-subsidise, 0= not willing) and for the log linear model dependent variable was the natural logarithm of actual amount stated while α, was the intercept; β, were coefficients of explanatory variables X. Computation of marginal effects on logit models was undertaken. We started by estimating the full model which contained all explanatory variables which might affect WTP for health insurance/ WT cross-subsidise. We also estimated a reduced model, using the backward elimination procedure in which we eliminated those variables with the highest p value conditional on the p value being bigger than some pre-determined level ( p>0.60). The models were subjected to various diagnostic tests, for the logit model we used the link test for model specification while for log linear models the RESET test (15) was used to ensure the model was appropriately specified and to test for omitted variable bias (16). Other tests on the log liner model included Shapiro-Wilk W test which was used to test the normality of the error term; the Breusch-Pagan to test the null hypothesis that the variance of the residuals is homogenous and the VIF (variance inflation factor) was examined to check for the presence of multicollinearity (16). Results Descriptive Statistics: The majority of the household heads were male (76%), aged 44 years, and 8% of household heads assessed their health status to be poor (Table 2). On average there were five members within a household. There were some differences in the characteristics of insured compared to uninsured household heads. The insured were more likely to be married, Christian, of higher wealth status, employed in the formal sector and have completed primary education than the uninsured (Table 2). The insured were also more likely to have sought care in the previous month (24% of the insured had an outpatient visit in the previous month compared to 13% of the uninsured), and they were less likely to be eligible for exemptions (8 % of the insured were eligible for exemptions compared to 19% of the uninsured) (Table 2). Willingness to Join and Pay for Health Insurance: Table 3 shows uninsured respondents were significantly more willing to join health insurance in urban than rural areas at the proposed rate of Tsh 5,000 (93% compared to 74%) (p<0.001). Moreover, there was a significant difference in the proportion of households in urban and rural areas willing to prepay for voluntary health insurance across socio-economic groups (p < 0.05). Willingness to pre-pay was consistently higher among higher than lower wealth groups. The size of the proposed benefit package affected people s willingness to join in rural areas, with 78% being willing to join in Mbulu and Singida districts where inpatient care was covered compared to 72% in Kigoma and Kilosa districts where only primary care was covered (p < 0.1) (Table 3). However, there was relatively limited willingness to pay more than Tsh 5,000 in either setting (in urban areas, only a third of respondents were willing to pay more than Tsh 5,000 whereas only 1% were willing to do so in rural areas). Among those who were willing to pay more than Tsh 5,000 there was no difference in the average amounts stated (mean Tsh 10,741 (Median:10,000) in urban areas; mean Tsh 10,000 (Median 10,000) in rural areas) (data not shown). Were the benefit package to expand in Kigoma and Kilosa, 79% of respondents would have been willing to join the CHF. In contrast, in urban areas, the benefit package had little effect on people s WTJ. Further, there was very limited willingness to pay more than Tsh 5,000, even with an expanded benefit package (only 2% of respondents were willing to pay more than Tsh 5,000 in rural areas compared to 39% in urban areas) [Data not shown]. Determinants of Willingness to Join and Pay for Health

4 February 2011 Ea s t Af r i c a n Me d i c a l Jo u r n a l 57 Table 1 Description of independent variables hypothesized to explain WTJ/WTP for insurance and willingness to crosssubsidise Independent variables WTJ/WTP for insurance WT cross-subsidise Gender Married Religion Occupation Self assessed health (SAH 4 ) Education Dar es Salaam Morogoro Dar es Salaam/ Morogoro Poor Male headed households will be more WTP and cross-subsidise than female headed households due to greater economic power. Married household heads will be more WTJ/WTP and willing to cross-subsidise than single households because they can more easily mobilize resources and they are more likely to have children/family friends who will be in need of health care. No prior hypothesis People with formal employment will be more WTJ/WTP and willing to cross-subsidise than others as they have a more sustainable source of income People whose self assessed health is poor will be more WTJ/WTP because they are in greater need than those with good self assessed health. They are less likely to be willing to cross-subsidise the poor as they have to care themselves. People whose self assessed health is average will be more WTJ/WTP as they are in greater need than those with good self assessed health. They are less likely to be willing to cross-subsidise the poor as they have to care for themselves. People with formal education will be more WTJ/WTP as well as willing to cross-subsidise because they are more aware of the importance for health care. Compared to rural households, households in Dar es Salaam will be more WTJ and WTP for health insurance because they are exposed to more accredited facilities, and have more economic activities where they earn income. They will be less willing to cross-subsidise the poor than those in rural areas as there is less solidarity. Compared to rural households, households in Morogoro will be more WTJ and WTP for health insurance because they are exposed to more accredited facilities, and have more economic activities where they earn income. They will be less willing to cross-subsidise the poor than those in rural areas as there is less solidarity. Compared to those in Morogoro, households in Dar es Salaam will be more WTJ and WTP for voluntary health insurance because of having more economic activities where they earn income. Exemption eligibility Those who are eligible for exemptions will be less likely to join and pay for health insurance as well as cross-subsidising the poor, because they are less aware of health care costs. NHIF NA NHIF members are more willing to cross-subsidise than CHF members because they have a more sustainable Outpatient visit to a formal provider in previous month Age income An individual who had a recent outpatient visit is more likely to be WTJ/WTP for insurance as they are in need of care; also they might have been made aware of the insurance scheme by health care attendants. They will be willing to cross-subsidise the poor because they are aware of the costs of health care. WTJ insurance is likely to increase with age due to greater need for care. However, WTP for insurance is likely to reduce with age due to lower income levels of the elderly. The elderly will be less willing to cross-subsidise the poor because of their own needs and income constraints.

5 58 Ea s t Af r i c a n Me d i c a l Jo u r n a l February 2011 Income Household Size Above 59 years Higher income levels lead to higher WTJ/WTP for insurance and willingness to cross subsidise the poor. Larger households will be more WTJ health insurance as the premium per person will be lower. They will be less WTP and willing to cross-subsidise the poor, due to the greater constraints on household income. Households with a larger number of elderly people will be more willing to join insurance due to their health care needs, but less willing to pay and less willing to cross-subsidise due to their more limited income. Table 2 Demographic and socio-economic characteristics of the surveyed households Variables Measurement Total n=2,222 % Gender Married Religion* Occupation Health Poor 1= male, 0 = female 1 = married 0 = otherwise 1 = Christian 0 = Muslim, or Hindu/Buddhist or no religion 1= formal [those with formal employment] 0 = informal or no employment 1 = poor 0 = otherwise Insured n=1,162 % Uninsured n=1,060 % Health Average Health Good (reference group) 1 = average 0 = otherwise 1 = good 0 = otherwise Education Dar es Salaam Morogoro 1 = completed primary education or above 0 = No formal education 1 = household is from Dar es Salaam 0= otherwise 1 = Household is from Morogoro 0= otherwise Dar es Salaam/ Morogoro 1 = household from Dar es Salaam 0= Morogoro Rural (reference group) Exemption eligibility 1 = household from rural areas 0= otherwise 1= eligible for exemptions 0 = not eligible for exemptions

6 February 2011 Ea s t Af r i c a n Me d i c a l Jo u r n a l 59 Insurance cover Outpatient visit to formal providers in previous month 1= NHIF member 0 = CHF member 1 = households reported a visit 0 = otherwise Continuous variables Age Income Household size Above 59 years Mean (Standard Deviation) Household age in years 44.08(14.2) 41(12.2) 44.38(14.4) Wealth index value (proxy of income) Number of people 0.245(3.0) 2.69(3.6) (2.7) who eat and sleep 5.18(2.6) 5.22(2.9) 5.18(2.6) within the house Number of people who are above 59 years in age in the 0.4(0.6) 0.2(0.5) 0.3(0.7) household Table 3 Willingness to pre-pay Tsh 5,000 per household per year, by geographic location and socio-economic status among uninsured respondents rural U urban Rural urban comparison Variables Kigoma/ Mbulu/ p-value Overall Kilosa Singida R rural Wealth n n n n p-value Groups (%) (%) (%) (%) (%) (%) Q1 32(70.1) 68(73.6) (72.0) 6(100) (Poorest) Q2 45(72.2) 37(73.1) (72.5) 11(78.5) Q3 43(65.8) 40(84.3) (71.4) 28(92.5) Q4 43(74.4) 24(89.6) (77.5) 58(90.2) Q5 (Least Poor) 22(79.0) 10(83.1) (80.1) 148(97.3) Overall 193(72.3) 181(78.1) (74.3) 265(93.1) Note to Table: Kigoma/Kilosa have a limited benefit package including primary care; Mbulu Singida have a broader package that includes inpatient care.

7 60 Ea s t Af r i c a n Me d i c a l Jo u r n a l February 2011 Table 4 Determinants of willingness to join (WTJ) and willingness to pay (WTP) for health insurance logit model - WTJ health insurance OLS- log linear model WTP for health insurance in urban areas Independent Coefficients (SE) Marginal effects Full Model Reduced variables (SE) Coefficient (SE) Model Coefficient (SE) Gender (0.27)** (0.05)** (0.09)* (0.08) Married (0.27) (0.04) (0.08) Religion (0.22) ** (0.03) ** (0.07) Occupation (0.53) (0.10) (0.08) Health Poor (0.34) (0.05) (0.15) Health Average (0.25) (0.03) (0.08) (0.07) Education (0.28)* (0.05)* (0.11) Dar es Salaam (0.51) *** (0.03)*** (0.8)* (0.07)* Morogoro (0.36) *** (0.02) *** Exemption Eligibility (0.48) (0.08) (0.12) Outpatient visit to (0.32) (0.04) (0.08) formal provider in previous month Age (0.01) (0.00) (0.00)* (0.00) Income (0.05) * (0.01) * (0.01)*** (0.01)*** Household Size (0.04) (0.01) (0.01) Above 59 years (0.23) (0.03) (0.07) Number of Observation Wald chi 2 /F statistics 73.3*** 4.74*** 11.1*** Pseudo/Adjusted R Note *, **, *** shows significance at 10%, 5 % and 1 %, MFX - marginal effect and SE - standard error Table 5 Determinants of Willingness to Cross-subsidise the Poor logit Model ols Log liner model WTP to cross subsidise Independent Coefficient Marginal Full Model Reduced Model variables (SE) Effects (SE) Coefficient (SE) Coefficient (SE) Gender (0.20)** (0.05)** (0.16) (0.16) Married (0.18) (0.04) (0.15) Religion (0.18) (0.04) (0.12) Occupation (0.47) (0.12) (0.22)** (0.22)** Health Poor (0.32)* (0.07)* (0.28) Health Average (0.18)** (0.04)** (0.12) Education (0.28) (0.06) (0.22) Dar es Salaam (0.41) (0.09) (0.31)** (0.29)** Morogoro (0.30) (0.07) (0.24) Exemption Eligibility (0.42) (0.09) (0.29)

8 February 2011 Ea s t Af r i c a n Me d i c a l Jo u r n a l 61 NHIF member (0.45) (0.11) (0.23) (0.22) Outpatient visit to (0.19)* (0.05)* (0.14)** (0.14)** formal provider in previous month Age (0.01)* (0.00)* (0.01)* (0.01)* Income (0.04) (0.01) (0.03)* (0.02) Household Size (0.03) (0.01) (0.02) Above 59 years (0.17) (0.04) (0.14) Number of Observation Wald chi 2 /F statistics 51.4*** 5.43*** 11.98*** Pseudo/Adjusted R Note *, **, *** shows significance at 10%, 5 % and 1 %, MFX - marginal effect and SE - standard error Insurance: Results from the logit model showed that gender, residing in Dar es Salaam or Morogoro, having a formal education, religion, and income significantly affect household WTJ the CHF/TIKA, when controlling for other variables, consistent with prior expectations (Table 4). Residing in Dares-Salaam and Morogoro increased the probability of being willing to join voluntary health insurance by sixteen and fifteen percent respectively. Being from a male headed household and having formal education increased the probability of willing to join insurance by fourteen and seven percentage points respectively. The coefficients on some of the variables (occupation, poor self assessed health status, and household size) had signs that were inconsistent with prior expectations, however they were not statistically significant. The log linear model showed that being from a male headed household, age, income of households, and residing in Dar es Salaam were the only variables influencing the actual amounts households were willing to pay for health insurance when controlling for other variables (Table 4). The coefficients on some of the variables (occupation, age, and having a recent outpatient visit) had signs that were inconsistent with prior expectations, however, they were not statistically significant. Willingness to Cross-subsidize the Poor: Overall there was a greater willingness to cross-subsidize the poor among rural compared to urban households (46.0% and 41.2% respectively (p < 0.05)), but the actual average amounts stated were lower in rural compared to urban areas (mean Tsh 6,620 (median Tsh 5,000) and Tsh 13,940 (median Tsh 10,000) respectively) [data not shown]. Moreover, the proportion of NHIF members who were willing to cross-subsidize the poor was significantly lower compared to CHF members (39% compared to 53%) (p < 0.01), but NHIF members were willing to cross-subsidise significantly higher average amounts than CHF members (mean Tsh 13,690 (median Tsh 5,000) and Tsh 4,790 (median Tsh 5,000), p<0.01). Determinants of Willingness to Cross-Subsidise the Poor: Table 5 shows the determinants of household willingness to cross-subsidise the poor. Being from a male headed household increased the probability of being willing to cross-subsidise by 11 percentage points. Having a recent outpatient visit to a formal provider increased the probability of being willing to cross-subsidise the poor by seven percentage points (p<0.1). Conversely, the elderly, and those with poor or average self assessed health were less willing to cross-subsidize the poor. The signs of the coefficients on all the variables met with prior expectations except for household size, although the coefficient on this variable was not significant. The log linear model indicated that richer households, and those working in the formal sector were willing to pay more in cross-subsidises for the poor, consistent with expectations (p<0.01). Counter to expectations, the elderly were more willing to pay for the poor, possibly due to a sense of solidarity with the poor, and those who had recently sought care were less willing to pay for the poor, possibly due to the costs incurred when care seeking. The signs on the coefficients of exemption eligibility and household size were also counter to expectations but these were not statistically significant. Discussion This study has shown that informal sector urban populations will be willing to join the TIKA scheme in urban areas if premiums remain low. However, only a

10 February 2011 Ea s t Af r i c a n Me d i c a l Jo u r n a l 63 they would not be willing to support higher income CHF members, but rather for their contributions to be earmarked to support poorer groups. This study is the first to look at the sensitivity of WTP for insurance to changes in the benefit package. This findings revealed very little effect of an expanded benefit package on WTP, this could be a result of our study design which provided only a very limited description of benefits, and overall insurance design. Future studies might explore household responsiveness to more specific design issues, such as the scope of services covered in the benefit package (and inclusion or not of drugs, which are often out of stock in public facilities, for example), the degree of service quality (in terms of staff availability and type of staff, for example), and the premium payment method (in cash or in kind, and the timing and frequency of payment). For example, in Ethiopia a study evaluated the willingness of households to pay for insurance in terms of labour (the amount of labour an individual is willing to contributes in terms of person days times the wage rate reported by the individual) (22). Discrete choice experiments would be a way of simultaneously addressing preferences across such a range of dimensions, and may offer more conclusive evidence of how to tailor the design of insurance schemes to specific communities to maximize and expand enrollment in efforts towards universal coverage. AcknowledgEments This study was support by International Development and Research Centre (Grant number ) and the European Commission (Sixth Framework Programme; Specific Targeted. Research Project no: 32289). REFERENCE 1. Ekman, B., Community-based health insurance in lowincome countries: a systematic review of the evidence. Health Policy Plan, : McIntyre, D., Garshong, B., Mtei, G., et al, Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania. Bull World Health Organ : Kamuzora, P., and Gilson, L. Factors influencing implementation of the Community Health Fund in Tanzania. Health Policy Plan, : Carrin, G., Waelkens, M., and Criel, B. Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop. Med. Int. Health, 2005; 10: Jehu-Appiah, C., Aryeetey, G., Spaan, E., et al. Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why? Soc. Sci Med, : Macha, J., Harris, B., Garshong, B., et al (in press) Factors Influencing the Burden of Health Care Financing and the Distribution of Health Care Benefits in Ghana, Tanzania and South Africa Goudge, J., Akazili, J., Ataguba, J., et al. (in press). Social solidarity and willingness to tolerate risk and income-related cross-subsidies within health insurance: experience from Ghana, Tanzania and South Africa, University of the Witwatersrand: South Africa. 8. Dong, H., Kouyate, B., Snow, R., et al. Gender s effect on willingness-to-pay for community-based insurance in Burkina Faso. Health Policy, : Mushi, D. P. Financing Public Health Care: Insurance, User Fees, or Taxes? Welfare Comparison in Tanzania. 2007, Research on Poverty Alleviation Dar es Salaam Onwujekwe, O., Okereke, E., Onoka, C., et al. Willingness to pay for community-based health insurance in Nigeria: do economic status and place of residence matter? Health Policy Plan, : p Dong, H., Kouyate, B., Cairns, J., and Sauerborn, R. Differential willingness of household heads to pay community-based health insurance premia for themselves and other household members. Health Policy Plan, : Humba, E., The Current Status of NHIF and CHF and Prospects for the coming 5 years in Technical Review Meeting. September, 2010: Blue Pearl Hotel, Dar es Salaam. 13. Mulligan, J., and Mtei, G. Community Health Funds in Tanzania: A Literature Review 2007; Ryan, M., Scott, D., Reeves, C., et al. Eliciting public preferences for healthcare: a systematic review of techniques. Health Technol Assess, : Ramsey, J. B. Test for Specification Errors in Classical Linear Least-squares Regression Analysis. J. Royal Stat. Soc : Long, S., and Freese, J. Regression Models for Categorical Dependent Variables Using Stata, 2nd Edition 2006, Stata Press. 17. Onwujekwe, O., and Uzochukwu, B. Stated and actual altruistic willingness to pay for insecticide-treated nets in Nigeria: validity of open-ended and binary with follow-up questions. Health Econ, : Jacobsson, F., Carstensen, J., and Borgquist, L. Caring externalities in health economic evaluation: how are they related to severity of illness? Health Policy, : URT, The Community Health Fund Act 2001, Government Printer; 1999.: Dar es Salaam 20. Aryeetey, G., Jehu-Appiah, C., Spaan, E., et al. Identification of poor households for premium exemptions in Ghana s National Health Insurance Scheme: empirical analysis of three strategies. Trop.

11 64 Ea s t Af r i c a n Me d i c a l Jo u r n a l February 2011 Med. Int. Health, : V Ride, M. Y., Kafando, O., Sanfo, N., et al. community - based targeting approach to exempt the worst - off from user fees in Burkina Faso. J. Epidemil. Community Health Asfaw, A., and Braun, J. Can community health insurance schemes shield the poor against the downside health effects of economic reforms? The case of rural ethiopia. Health Policy, :

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