A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone

Joseph Kamara; Mireia Jofre Bonet; Alice Mesnard

doi:doi:10.11648/j.hep.20180301.11

| Peer-Reviewed

A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone

Joseph Kamara, Mireia Jofre Bonet, Alice Mesnard

Published in International Journal of Health Economics and Policy (Volume 3, Issue 1)

Received: 17 March 2018 Accepted: 7 May 2018 Published: 29 May 2018

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

The current health care financing system in Sierra Leone is unsustainable and poses challenges ranging from increased in out of pocket health care expenditure to accessibility problems, particularly in rural areas where living standards are low and health care facilities are scarce. This paper investigates whether privately financed health Insurance can improve the accessibility to formal health care in Sierra Leone and mitigate the effects of OOPs on poor households. To do so, we estimate the Willingness To Pay (WTP) for health insurance among informal sector workers in Sierra Leone using a Discrete Choice Experiment approach. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding, cattle rearing, fishing, tailoring, mining and quarrying. A random effect logit model is used to estimate households’ WTP for an improvement in coverage, choice of health care provider and a reduction in waiting time. Our study reveals that households were WTP more to have better attributes (better coverage, less waiting time) and to go to a faith - based provider. Our findings also suggest that location – rural versus urban – matters in determining the WTP since urban households were WTP more for health insurance than their rural counterparts, (SLL 54,348 or $7.34) and (SLL 37,250.5 or $5.03), respectively.

Published in	International Journal of Health Economics and Policy (Volume 3, Issue 1)
DOI	10.11648/j.hep.20180301.11
Page(s)	1-12
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Health Insurance, Willingness to Pay, Discrete Choice Experiment, Informal Sector, Sierra Leone, Sierra Leonean Leones

References

[1]	Arhin-Tenkorang, D. (2001): Health Insurance for the Informal Sector in Africa: Design Features, Risk Protection, and Resource Mobilization. Health, Nutrition and Population Discussion Paper, World Bank.
[2]	Asfaw, Gustafsson-Wright and van der Gaag (2009) WTP for health insurance: An analysis of the potential products for new lost cost health insurance in Namibia. Social Science and Medicine 69 (9): 135 – 159.
[3]	Bateman, I., R. Carson, B. Day, M. Hanemann, N. Hanley, S. Mourato, E. Ozdemiroglu, D. W. Pearce, and R. Sugden (2002): Economic Valuation with Stated Preference Techniques: a Manual. Cheltenham: Edward Elgar.
[4]	Campbell, D (2006) Combining Mixed Logit Models and Random Effect Models to identify the determinants of willingness to pay for rural landscape improvements; Paper written for the Agricultural Economics Society 81st Annual Conference, Reading, March 2006.
[5]	Chaugule, S., Hay, J. W., and G. Young (2015): Understanding Patient Preferences and Willingness to Pay for Hemophilia Therapies. Patient Preference and Adherence 2015: 9; 1623 – 1630.
[6]	Deaton, A., and C. H. Paxson (1997): The effects of economic and population growth on national saving and inequality. Demography 34 (1): 97 – 114.
[7]	De Bekker – Grob, E. W., Donkers, B., Jonker, M. F., E. A Stock (2015): Sample size requirements for Discrete Choice Experiments in Health Care: A Practical Guide. Patient (2015) 8: 373 – 384.
[8]	Donfouet, H. P, E. Makaudze, P. A. Mahieu, and E. Malin (2011) The determinants of willingness to pay for community-based prepayment scheme in rural Cameroon. International Journal of Health Care Finance and Economics 11(3): 209 – 220.
[9]	Dong H, B. Kouyate, J. Cairns, F. Mugisha, and R. Sauerborn (2003) Willingness to pay for community based health insurance in Burkina Faso; Health Economics 12: 849 – 862.
[10]	Escobar, M., C. C. Griffin, & R. P. Shaw, (2010): The impact of Health Insurance in Low – and Middle – Income Countries. The Brookings Institution Press, Washington DC.
[11]	Geidl, W., Knocke, K., Schupp, W., and K. Pfeifer (2018): Measuring Stroke Patient’s Exercise Preferences using a Discrete Choice Experiment. Neurology International 2018; 10: 6993.
[12]	Ghosh, S., and S. Mondal, (2011): Morbidity, Health Expenditure and WTP for HI amongst the Urban Poor: A Case Study. Journal of Health Management 2011 13: 419.
[13]	Greene, W. H., (2003) Econometric Analysis. Upper Saddle River: Prentice - Hall.
[14]	Hanley, N., Mourato, S., and Wright, S. E (2001) Choice Modelling Approaches: A Superior Alternative for Environmental Valuation. Journal of Economic Surveys 15(3): 435 – 462.
[15]	Hanson, K.; and J. William (2010) Incentives that could induce Ethiopian doctors and nurses to work in rural settings; Health Affairs (Millwood) 29 (8): 1452 – 60 (Technical Appendix).
[16]	Harapan, H., Fajar, J. K., Sasmono, R. T., and Kuch, U (2017): Dengue Vaccine Acceptance and Willingness to Pay. Human Vaccines and Immunotherapeutic 2017, Vol. 13 No. 4, 786 – 790.
[17]	Hensher, D. A.; J. M. Rose, and W. H. Greene, (2005): Applied Choice Analysis – A Primer. Cambridge University Press, UK.
[18]	Johnson, F. R.; E. Lancsar, E. Marshall, V. Kilambi, A. Muhlbacher, D. A. Regier, B. W. Bresnahan, B. Kanninen, J. F. P. Bridges, (2013): Constructing Experimental Designs for Discrete-Choice Experiments: Report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force. Value in Health 16; 3 – 13.
[19]	Justino, P. (2007): Social security in developing countries: Myth or necessity? Evidence from India, Journal of International Development, Vol. 32, No. 2, pp. 273 – 288.
[20]	Kamara, F. S (2008) Economic and Social crises in Sierra Leone: The role of small-scale entrepreneurs in petty trading as a strategy for survival, 1990 – 1996; Bloomington, Indiana, US.
[21]	Kielhorn, A. And J. M. Schulenburg, (2000): The health economics handbook. 2nd ed., Adis International Limited, England.
[22]	Lancaster, K. (1966): A new approach to consumer theory, Journal of Political Economy, Vol. 74, pp. 132-157.
[23]	Lancsar, E. and J. Louviere, (2008): Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: a User’s Guide. Pharmacoeconomics, 26 (8), pp. 661-677.
[24]	Mangham, L. J., K. Hanson, and B. McPake, (2008) How to do (or not to do): Designing a discrete choice experiment for application in a low - income country; Health Policy Plan 2009, 24:151 – 158.
[25]	Manski, C (1977) the structure of random utility models. Theory and Decisions 8 (3) 229 – 254.
[26]	McFadden, D. (1974) Conditional logit analysis of qualitative choice behaviour, In P. Zarembka (ed.) Frontiers in Econometrics, New York: Academic Press, 105-142.
[27]	Moia M, L. G Mantovani, M. Carpenedo, L. Scalone, M. S. Monzini, G. Cesana, and P. M. Mannucci (2013) Patient preferences and willingness to pay for different options of anticoagulant therapy; Intern Emerg Med 8: 237 – 243.
[28]	Mooney, G. (2003): Economics, Medicine and Health Care, 3rd ed., Prentice Hall, London, U. K.
[29]	Mulhern, B., Bansback, N., Hole, A. R., and Tsuchiya, A (2017): Using Discrete Choice Experiments with duration to model EQ – 5D – 5L Health State Preferences: Testing Experimental Design Strategies. Medical Decision Making 2017; 37: 285 – 297.
[30]	Rakotonarivo, S., Schaafsma, M., and Hockley, N (2016): A Systematic Review of the reliability and validity of Discrete Choice Experiments in Valuing Non-Market Environmental Goods. Journal of Environmental Management 183 (Part 1) 98 – 109.
[31]	Ramsey, T. Z., Skov, M., Christensen, M. K., and Stahlhurt, C (2018): Frontal Brain Asymmetry and Willingness to Pay. Front. Neurosci. 12:138. 2018.
[32]	Research for Development (2013) Closing the Gap: The global experience in providing health insurance coverage for informal sector workers.
[33]	Ryan, M. and K. Gerard, (2003): ‘Using discrete choice experiment to value health care programs: current practice and future research reflections’. Applied Health Economics and Health Policy, Vol. 2 (1), pp. 55-64.
[34]	Ryan, M.; Gerard, K., and Amaya – Amaya, M (2010): Using Discrete Choice Experiments to Value Health and Health Care (The Economics of Non-Market Goods and Resources). Springer, Dordrecht The Netherlands.
[35]	Scott, A. (2001) Eliciting GP’s preferences for pecuniary and non-pecuniary job characteristics; Journal of Health Economics, 20: 329 – 347.
[36]	Seghieri C, A. Mengoni, and S. Nuti (2014) Applying Discrete Choice Modeling in a Priority Setting: an Investigation of Public Preferences for Primary Care Models. European Journal of Health Economics 15: 773 – 785.
[37]	Street, D. and L. B. Burgess (2007): The Construction of Optimal Stated Choice Experiments: Theory and Methods, John Wiley and Sons, Hoboken, New Jersey.
[38]	Terris – Prestholt, F., Quaife, M., and Vickerman, P (2016): Parameterising user uptake in Economic Evaluations: The Role of Discrete Choice Experiments. Health Economics 25 (Suppl. 1): 116 – 123 (2016).
[39]	Vroomen, J. M., and P. Zweifel (2011): Preferences for health insurance and health status: does it matter whether you are Dutch or German? European Journal of Health Economics (2011) 12:87–95.
[40]	World Bank (2013) http://data.worldbank.org/country/sierra_leone.

Cite This Article

Plain Text BibTeX RIS

APA Style

Joseph Kamara, Mireia Jofre Bonet, Alice Mesnard. (2018). A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone. International Journal of Health Economics and Policy, 3(1), 1-12. https://doi.org/10.11648/j.hep.20180301.11

Copy | Download

ACS Style

Joseph Kamara; Mireia Jofre Bonet; Alice Mesnard. A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone. Int. J. Health Econ. Policy 2018, 3(1), 1-12. doi: 10.11648/j.hep.20180301.11

Copy | Download

AMA Style

Joseph Kamara, Mireia Jofre Bonet, Alice Mesnard. A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone. Int J Health Econ Policy. 2018;3(1):1-12. doi: 10.11648/j.hep.20180301.11

Copy | Download

@article{10.11648/j.hep.20180301.11,
  author = {Joseph Kamara and Mireia Jofre Bonet and Alice Mesnard},
  title = {A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone},
  journal = {International Journal of Health Economics and Policy},
  volume = {3},
  number = {1},
  pages = {1-12},
  doi = {10.11648/j.hep.20180301.11},
  url = {https://doi.org/10.11648/j.hep.20180301.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20180301.11},
  abstract = {The current health care financing system in Sierra Leone is unsustainable and poses challenges ranging from increased in out of pocket health care expenditure to accessibility problems, particularly in rural areas where living standards are low and health care facilities are scarce. This paper investigates whether privately financed health Insurance can improve the accessibility to formal health care in Sierra Leone and mitigate the effects of OOPs on poor households. To do so, we estimate the Willingness To Pay (WTP) for health insurance among informal sector workers in Sierra Leone using a Discrete Choice Experiment approach. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding, cattle rearing, fishing, tailoring, mining and quarrying. A random effect logit model is used to estimate households’ WTP for an improvement in coverage, choice of health care provider and a reduction in waiting time. Our study reveals that households were WTP more to have better attributes (better coverage, less waiting time) and to go to a faith - based provider. Our findings also suggest that location – rural versus urban – matters in determining the WTP since urban households were WTP more for health insurance than their rural counterparts, (SLL 54,348 or $7.34) and (SLL 37,250.5 or $5.03), respectively.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone
AU  - Joseph Kamara
AU  - Mireia Jofre Bonet
AU  - Alice Mesnard
Y1  - 2018/05/29
PY  - 2018
N1  - https://doi.org/10.11648/j.hep.20180301.11
DO  - 10.11648/j.hep.20180301.11
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 1
EP  - 12
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20180301.11
AB  - The current health care financing system in Sierra Leone is unsustainable and poses challenges ranging from increased in out of pocket health care expenditure to accessibility problems, particularly in rural areas where living standards are low and health care facilities are scarce. This paper investigates whether privately financed health Insurance can improve the accessibility to formal health care in Sierra Leone and mitigate the effects of OOPs on poor households. To do so, we estimate the Willingness To Pay (WTP) for health insurance among informal sector workers in Sierra Leone using a Discrete Choice Experiment approach. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding, cattle rearing, fishing, tailoring, mining and quarrying. A random effect logit model is used to estimate households’ WTP for an improvement in coverage, choice of health care provider and a reduction in waiting time. Our study reveals that households were WTP more to have better attributes (better coverage, less waiting time) and to go to a faith - based provider. Our findings also suggest that location – rural versus urban – matters in determining the WTP since urban households were WTP more for health insurance than their rural counterparts, (SLL 54,348 or $7.34) and (SLL 37,250.5 or $5.03), respectively.
VL  - 3
IS  - 1
ER  -

Copy | Download

Author Information

Joseph Kamara

Sierra Leone Social Health Insurance (SLeSHI) Scheme, Freetown, Sierra Leone
Mireia Jofre Bonet

Department of Economics, City University of London, London, UK
Alice Mesnard

Department of Economics, City University of London, London, UK

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Joseph Kamara, Mireia Jofre Bonet, Alice Mesnard. (2018). A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone. International Journal of Health Economics and Policy, 3(1), 1-12. https://doi.org/10.11648/j.hep.20180301.11

Copy | Download

ACS Style

Joseph Kamara; Mireia Jofre Bonet; Alice Mesnard. A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone. Int. J. Health Econ. Policy 2018, 3(1), 1-12. doi: 10.11648/j.hep.20180301.11

Copy | Download

AMA Style

Joseph Kamara, Mireia Jofre Bonet, Alice Mesnard. A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone. Int J Health Econ Policy. 2018;3(1):1-12. doi: 10.11648/j.hep.20180301.11

Copy | Download

@article{10.11648/j.hep.20180301.11,
  author = {Joseph Kamara and Mireia Jofre Bonet and Alice Mesnard},
  title = {A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone},
  journal = {International Journal of Health Economics and Policy},
  volume = {3},
  number = {1},
  pages = {1-12},
  doi = {10.11648/j.hep.20180301.11},
  url = {https://doi.org/10.11648/j.hep.20180301.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20180301.11},
  abstract = {The current health care financing system in Sierra Leone is unsustainable and poses challenges ranging from increased in out of pocket health care expenditure to accessibility problems, particularly in rural areas where living standards are low and health care facilities are scarce. This paper investigates whether privately financed health Insurance can improve the accessibility to formal health care in Sierra Leone and mitigate the effects of OOPs on poor households. To do so, we estimate the Willingness To Pay (WTP) for health insurance among informal sector workers in Sierra Leone using a Discrete Choice Experiment approach. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding, cattle rearing, fishing, tailoring, mining and quarrying. A random effect logit model is used to estimate households’ WTP for an improvement in coverage, choice of health care provider and a reduction in waiting time. Our study reveals that households were WTP more to have better attributes (better coverage, less waiting time) and to go to a faith - based provider. Our findings also suggest that location – rural versus urban – matters in determining the WTP since urban households were WTP more for health insurance than their rural counterparts, (SLL 54,348 or $7.34) and (SLL 37,250.5 or $5.03), respectively.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone
AU  - Joseph Kamara
AU  - Mireia Jofre Bonet
AU  - Alice Mesnard
Y1  - 2018/05/29
PY  - 2018
N1  - https://doi.org/10.11648/j.hep.20180301.11
DO  - 10.11648/j.hep.20180301.11
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 1
EP  - 12
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20180301.11
AB  - The current health care financing system in Sierra Leone is unsustainable and poses challenges ranging from increased in out of pocket health care expenditure to accessibility problems, particularly in rural areas where living standards are low and health care facilities are scarce. This paper investigates whether privately financed health Insurance can improve the accessibility to formal health care in Sierra Leone and mitigate the effects of OOPs on poor households. To do so, we estimate the Willingness To Pay (WTP) for health insurance among informal sector workers in Sierra Leone using a Discrete Choice Experiment approach. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding, cattle rearing, fishing, tailoring, mining and quarrying. A random effect logit model is used to estimate households’ WTP for an improvement in coverage, choice of health care provider and a reduction in waiting time. Our study reveals that households were WTP more to have better attributes (better coverage, less waiting time) and to go to a faith - based provider. Our findings also suggest that location – rural versus urban – matters in determining the WTP since urban households were WTP more for health insurance than their rural counterparts, (SLL 54,348 or $7.34) and (SLL 37,250.5 or $5.03), respectively.
VL  - 3
IS  - 1
ER  -

Copy | Download