Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

• Published in: PloS one Vol. 11; no. 6; p. e0157470
• Main Authors: Nosratnejad, Shirin, Rashidian, Arash, Dror, David Mark
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.06.2016; Public Library of Science (PLoS)
• Subjects: Analysis; Confidence intervals; Developing Countries; Economics; Expenditures; Family size; Financing, Personal - economics; Grey literature; Health care; Health care policy; Health informatics; Health insurance; Health insurance industry; Health services; Health Services Accessibility - economics; Households; Humans; Income; Informal economy; Insurance; Insurance coverage; Insurance, Health - economics; Literature reviews; Mathematical analysis; Medicine and Health Sciences; Meta-analysis; Methods; National health insurance; Physical Sciences; Population; Poverty; Research and Analysis Methods; Rural areas; Rural Population; Science; Search strategies; Social Sciences; Studies; Systematic review; Universal Health Insurance - economics; Willingness to pay; Cameroon; Iran; Africa; India
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0157470

Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature. We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP. 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP. The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.