Household preferences and willingness to pay for health insurance in Kawempe division: a discrete choice experiment.

Abstract

Background: Uganda is in discussions to introduce a national health insurance scheme. However, there is a paucity of information on household preferences and willingness to pay for health insurance attributes that may guide the design of an acceptable health insurance scheme. This study sought to assess households’ preferences and willingness to pay for health insurance using a discrete choice experiment. Methods: A discrete choice experiment was conducted from 16th February 2020 to 10th April 2020 on 240 households in the Kawempe division stratified into slum (Katanga) and non-slum (Kyebando Nsooba) communities. Guided by literature review and prior qualitative research, I generated 4 household and policy-relevant attributes that were later used in the experimental design of the discrete choice experiment. Each respondent was presented with 9 binary choice sets of health insurance plans that included a fixed choice set. Data were analyzed using mixed logit models. Results: Households from the non-slum community considered the following attributes important in determining their choice: unit of enrollment as extended family (β = 0.44, P<0.05, WTP= UGX 206,960) and unit of enrollment with restrictions on the number of children to three (β = -0.90, P<0.05, WTP= UGX 41,893) versus unit of enrollment with no restrictions on the number of children; and receiving health care from both private and public providers versus receiving health care from public providers only (β=0.81, P<0.05, WTP= UGX 377,057). Households from the slum community considered the following attributes important in determining their choice: unit of enrollment as extended family (β=0.36, p<0.05, WTP= UGX 40,937) and unit of enrollment with restrictions on the number of children to three (β=-0.32, p<0.05, WTP= UGX 36,540) versus unit of enrollment with no restrictions on the number of children; and receiving health care from both private and public providers versus receiving health care from public providers only (β=0.87, p<0.05, WTP= UGX 98,738). The uptake rates for possible health insurance plans were highest when both public and private providers were included (52% in the non-slum community and 55% in the slum community). Conclusion: To maximize consumer utility and acceptance, potential health insurance schemes should consider coverage for chronic illnesses and major surgeries particularly for non-slum communities; including both private and public providers; and consider fewer restrictions on the number of family members allowed. However, the inclusion of more family members needs to be weighed against the possible depletion of resources and other attributes.