A COMPARATIVE STUDY OF HOUSE HOLD WILLINGNESS TO PAY FOR COMMUNITY-BASED HEALTH INSURANCE IN URBAN AND RURAL LOCAL GOVERNMENT AREAS IN LAGOS STATE

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A COMPARATIVE STUDY OF HOUSE HOLD WILLINGNESS TO PAY FOR COMMUNITY-BASED HEALTH INSURANCE IN URBAN AND RURAL LOCAL GOVERNMENT AREAS IN LAGOS STATE

Abstract

INTRODUCTION: Community-based health insurance is increasingly being recognized as a potentially powerful instrument for granting households access to health services in a more equitable way.
AIM: The aim of the study is to assess and compare the perception and willingness to pay for community based health insurance among households in urban and rural LGAs in Lagos.
METHODS: A comparative cross-sectional design was used. The sample size was calculated using the formula for comparison of proportions of two independent groups and respondents were selected using a multistage sampling technique. A pretested semi structured interviewer administered questionnaire was used to collect information from 480 households in an urban and rural LGA in Lagos. This is a study of household WTP, rather than individual WTP, as the economic decision to purchase health care among these households is more likely to be a household decision and not an individual one. Contingent valuation method was used to elicit household willingness to pay for a proposed community based insurance scheme. Data analysis was done using SPSS 17.0. The Chi square and Fishers exact tests were used for comparison of proportions and the Student t test for comparison of means. Multiple logistic regressions were carried out to assess the relationship between predictors and willingness to pay. An association with p value of < 0.05 was considered statistically significant.
RESULTS: The results indicate that 86.3% of the households in the rural LGA and 78.6% of the households in the urban LGA were willing to pay for a proposed community based health insurance scheme. This difference was statistically significant (p=<0.001). It also elicited that the mean amount that the respondents were willing to pay for individual enrolees was ₦555.23/person/month in the urban and ₦542.19/person/month in the rural. This difference was statistically significant (p=0.001). The mean amount they were willingness to pay for
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their household in the urban and rural area was ₦957.56 and ₦754.83/household/month respectively. The difference in the means was statistically significant (p<0.001).
Perceived reasons given by respondents for unwillingness’ to pay for the scheme includes the respondents’ lack of confidence in the managers of the scheme and that they felt they could not afford the premiums. Furthermore age, level of education, income, household size, and confidence in the managers of the scheme were determinants of willingness to pay.
CONCLUSION AND RECOMMENDATION: This study highlights the high willingness of the respondents to participate in the scheme and has the potential to increase access to quality health care in rural and urban areas in Lagos. The reported premiums gotten from this study can be applied to the populace. There is need for educating the population on the concept of insurance and risk management. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among those with relatively low education, low income groups, large households and the elderly.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

 

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

 

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

 

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

 

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

 

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

A COMPARATIVE STUDY OF HOUSE HOLD WILLINGNESS TO PAY FOR COMMUNITY-BASED HEALTH INSURANCE IN URBAN AND RURAL LOCAL GOVERNMENT AREAS IN LAGOS STATE

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