Willingness to participate and to pay for National Health Insurance in St. Vincent and the Grenadines: A Contingent Valuation Study

• Main Authors: Rosmond Romando Olando Adams, 羅世德
• Other Authors: Yiing-Jenq Chou
• Format: Others
• Language: en_US
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/14683924218651475179

碩士 === 國立陽明大學 === 國際衛生碩士學位學程 === 101 === ABSTRACT Background: Developing countries like St. Vincent and the Grenadines are struggling to find optimal ways to finance design and implement universal health care. With constrained government budget for health care being the major setback, new and intuitive ways must be sought to finance the sector. A National Health Insurance scheme can serve as a viable alternative by increasing income flow for the sector, increase cost recovery and protect the poor against the negative financial shock of illness. Objective: The aim of this study is to investigate the willingness to participate and the willingness to pay for a proposed National Health Insurance Plan (NHIP) in St. Vincent and the Grenadines among household heads for themselves and for their household. Method: This study took place in St. Vincent and the Grenadines during the period August to September 2012. It used national representative primary survey data. A pre-tested interviewer administered structured questionnaire was used to collect the information from a total of 400 respondents selected by simple random sampling. Contingent valuation was used to elicit willingness to pay using the bidding game technique. Data was examined for correlation between the independent variables and the willingness to participate and to pay. Chi-square test was used to investigate the association between the independent variables and willingness to participate in the proposed NHIP. Multivariate logistic regressions were used to determine the factors associated with willingness to participate and ordinary least square regressions were used to determine the factors associated with willingness to pay. Results: Overall, 69.5% of the respondents decided to participate in the proposed insurance plan. Of these respondents all of them were willing to pay for themselves and 76.26% (n=212) were willing to pay to enroll their household. The average maximum willingness to pay for the respondents was ECD*$77.66 for themselves and ECD$97.59 to cover their household. In the chi-square analysis, age, education, income, employment status, health status, health insurance ownership and the level of satisfaction with the public health care system were all associated with willingness to participate. In the multivariate logistic regression models, age, income and health insurance ownership were statistically significant. Age was negatively associated with willingness to participate while both income and health insurance were positively associated. Concerning willingness to pay for self, respondents who were more educated, earn more income and have health insurance were willing to pay. Where willingness to pay for other household members is concerned, marital status and income were the determining factors. Unmarried respondents were willing to pay ECD $25 more than those who were married and respondents who earned more than ECD$1000 monthly were willing to pay ECD $58.04 more than those who earned less than ECD$500 monthly. Conclusion: The high level of willingness to join and willingness to pay is an indication that the people of St. Vincent and the Grenadines will accept a NHIP. Socio-economic status, place of residence, health insurance ownership, among other factors determine peoples’ willingness to participate and to pay for the NHIP. Awareness will be needed for people of lower socio-economic status in order to increase their participation in the plan and also their willingness to pay. A NHIP therefore has the potential of being a reliable income flow for the health sector in St. Vincent and the Grenadines. Keywords: National health insurance, willingness to participate, willingness to pay, universal health care, contingent valuation, St. Vincent and the Grenadines *US$ 1 = ECD$ 2.70