Factors Associated with Willingness to Pay for Social Health Insurance among Government Employees in Tigrai Region, Northern Ethiopia

Abstract

Introduction: Developing countries seldom use social health insurance (SHI), and their healthcare finances mostly rely on general revenues and direct  out-of-pocket payments. This study investigated the level and factors associated with willingness to pay for SHI among government employees in Tigrai region, North Ethiopia.

Methods: An institution-based quantitative cross-sectional study was carried out from June to July 2018 among government employees in Tigrai, Ethiopia. Sample size was determined using single population proportion formula, and multi-stage cluster sampling was used to select the study  participants. Data collected using an interviewer-administered questionnaire was analyzed using SPSS Version 20.

Results: There were 544 (64.5%) respondents who were not willing to pay for SHI. Respondents age older than 39 years were 2.2 times more likely to be  willing to pay for SHI, as were those who disagreed with the binding rule of referral system (1.4 times), and with exclusion of periodic medical checkup  from the SHI (1.4 times), those who didn’t consider health service quality to be poor (1.6 times), and those who disagreed with the presence of financial  insecurity in health institutions (1.7 times).

Conclusion: This study revealed that government employees’ willingness to pay for SHI was low. SHI agencies  should publicize the proclamation for SHI and induce employees with SHI referral system, services excluded, and health facilities’ readiness and service  quality to increase willingness to pay. In addition, the government should reconsider the implementation of the proclamation for SHI accordingly.