Using willingness to pay data to inform the design of health insurance: Evidence from Nigeria
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1 Using willingness to pay data to inform the design of health insurance: Evidence from Nigeria Alison Comfort, Ph.D. Private Sector Working Group February 6, 2013
2 Background Lack of access to health insurance can lead individuals to forgo seeking care or to incur significant out-of-pocket expenses Limited access to health insurance in developing countries, particularly among informal sector workers PATHS2 (DfID-funded Abt Associates project) is working to expand coverage of health insurance among informal sector workers Establishing links between Health Maintenance Organizations (HMOs) and Micro-Finance Banks (MFBs) in Lagos State, Nigeria
3 PPPHI Network
4 Willingness to pay study The purpose of the study was to understand: Interest in different insurance packages Willingness to pay for health insurance Demographic and socio-economic characteristics Health seeking behavior and health expenses Knowledge and experience with health insurance Aim of study: inform design and implementation of insurance package Sample: 3 MFBs; biased towards 1 MFB Total sample = 1,343 clients
5 Baseline characteristics Female 90% Baseline characteristics Spouse of HH head 73% Age 39 HH size 5 Ever attended school 90% Primary school 25% Savings account 26,329 Naira (168 USD) Size of loan 37,945 Naira (242 USD) Health event in last month (in HH) 14% Health event in last month (client) 8% Type of provider OPD only 61% IPD only 9% No provider 30% Total OPD costs 5,088 Naira (32 USD) Total IPD costs 8,262 Naira (53 USD) Ever heard of health insurance 13%
6 Most preferred insurance package 30% 28% 25% 20% 15% 20% 19% 18% 17% 10% 5% 0% Outpatient only Childbirth only Inpatient & Outpatient Inpatient only Pharmaceuticals only
7 WTP by type of coverage (monthly) 1,200 1, Naira 6.0 USD 843 Naira 5.2USD 820 Naira 5.1USD 801 Naira 4.9 USD 695 Naira 4.3 USD Childbirth Pharmaceuticals only Inpatient only Inpatient & Outpatient Outpatient only
8 WTP for health insurance relative to health expenditure and total consumption Monthly consumption (n = 1,239) Monthly health expenditure (n = 1,239) HE/Total Consumption WTP for 1st choice package (n = 1,117) WTP/TC per respondent WTP/HE per respondent TOTAL 7, % % 3.70 On average, clients spend 2.85% of monthly consumption on health events. Given clients WTP 813 Naira per month for health insurance, they are willing to spend more than 10% of monthly consumption on health insurance. Clients are willing to pay almost 4 times their monthly spending on health to purchase insurance.
9 Incentives for enrollment Most popular incentives to motivate enrollment: Education about health insurance (58%) Free health check-up (53%) Premium reduction (41%) Other goods: cookware (39%), airtime (36%), bed nets (33%) Rewards program for health visit (35%) or food (32%)
10 Informing insurance product design Marketing about health insurance is critical given low knowledge and exposure Marketing and distribution adapted to demographics Overall interest in health insurance, particularly outpatient coverage Relatively high WTP for insurance Premium financing Transportation and cash support integration Incentives for take-up
11 Follow-up research Even when insurance coverage is offered at an affordable price with desirable benefits, there may still be low take-up Purpose of follow-up study: Evaluate the role of different nudges and their effect on insurance take-up Evaluate the impact of insurance coverage on access to care, financial risk protection, health outcomes, and willingness to renew insurance
12 Methodological approach Randomize the offer of incentives linked to insurance take-up Group 1: nudge 1 (airtime?) Group 2: nudge 2 (price reduction?) Group 3: nudge 3 (in-depth marketing) Group 4: offer insurance but no nudge RCT design to evaluate impact of different nudges on take-up of health insurance Randomized encouragement design to identify impact of health insurance on: Access to health services, out of pocket spending on health care, and objective health outcomes
13 Thank you For further comments:
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