WILLINGNESS TO PAY FOR SOCIAL HEALTH INSURANCE AND ITS

ASSOCIATED FACTORS AMONG PUBLIC SERVANTS INLIDETA SUB-

CITY, ADISS ABABA, ETHIOPIA, 2023.

Advisor: - Alemu Tesfahun (Ph.D candidate)

By; GETACHEW JUFARE (BSc)
Feb, 2024.G .C
ADDIS ABABA, ETHIOPIA
 Presentation outline
 Introduction
 Significance of the study
 Conceptual framework
 Objective
 Methods and Materials
 Results and Discussions
 Conclusion and Recommendation
 Limitation
 Acknowledgment

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 Introduction

Social protection, is policies and programs that help individuals and societies

 Manage risk and volatility,

 Protect them from poverty and inequality,

Help them access economic opportunity.

Social health insurance is a form of organizational mechanism for

 Raising and pooling funds to finance and manage health services that will lead to UHC

 Assist countries achieve their health systems objectively (Robalino DA, 2013)

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 Intro……continued

The key functions of the health financing system framework designed by the
World Health Organization are:,
Revenue raising,

Pooling and

 Purchasing of health services (Organization WH, 2007)

Legal frameworks were developed and many preparatory activities have been made to
implement the Social Health Insurance Scheme in which government employees shall
contribute 3% of their gross salary (Organization WH, 2018)

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 Statement of the problem
To achieve universal health coverage (UHC), social health insurance
plays a crucial role without incurring financial hardship.

Developed countries often use SHI to mobilize funds and pool risks,
but

Low and middle income countries rarely use SHI (Gall-Ely L., 2009).

In 2018, only 38% of the eligible population joined the community
health insurance program (Alebachew A, 2015)
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 continued

Public servants’ resistance to pay the proposed amount of premium 2009 in

ethiopia was the one factor that postpone the implementation of SHI.

Despite the fact that there is no national study on Willingness to Pay (WTP)
for SHI in Ethiopia (Lavers T, 2016)

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 Significance of the study

This study finding

Will generate information on the magnitude and contributing factors of the

willingness to pay SHI among public servants .

will be used by future researcher

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 Conceptual framework
 Socio-demographic
Factors
 Sex
 Marital status Health and health related factors

 Income  Health status of the families/

Willingness to pay for
 Level of education workers
social health insurance
 Family size  Individual with chronic disease.
 Reasons for going to health
facilities for treatment.
SHI related factors
 Services and costs of health care
 Premium affordability
 Way to obtain money for health
 Scheme awareness
care.
and benefits of
the scheme

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 OBJECTIVES
 General Objective

To assess willingness to pay for social health insurance and its associated factors
among public servants in Lideta Sub City, Addis Ababa, Ethiopia 2023.

 Specific objectives
To estimate the magnitude of the willingness to pay for social health insurance
among public servants in Lideta sub- city, Addis Ababa, Ethiopia 2023

To identify factors associated with willingness to pay for social health insurance
among public servants in Lideta sub-city, Addis Ababa, Ethiopia 2023
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 Methods and Materials

Descriptions
MeMethods

Study area Lideta sub-city, Addis Ababa, ethiopia, and from September 15 and
and period November 15, 2023.
Study design cross-sectional study design was conducted.

All civil servants in Lideta Sub City administration during the study time.
Source
population
Study All selected public servants working in Lideta sub city administration during
population the study time and fulfill the inclusion criteria.
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 Method and method…..Continued
Inclusion criteria
All employments in Lideta sub city public servants who are permanent employee
of the sub city under governmental institution.

Exclusion criteria
Workers who were on annual leave during study time and not permanent or less
than 6 month employee of the sub city.

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 Method and method…..Continued

Sample size determination

Assumptions
 5% marginal error and

 95% confidence interval (alpha=0.05)

 proportion or prevalence of SHI from previous study = 53% ( 27)

n = (z α/2)2 *p(1-p) =(1.96)2 *0.53*0.47 =383

d2 (0.05)2
Then 10% non-respondent added =421.
By using correction formula the final sample size was 381.

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 Study Variables
Dependent variable
 Willingness to pay for social health insurance

Independent variables

Socio-Demographic Factors:

(Sex, Marital status, income, level of education, Family size, and Number of dependent family members)

Health and health related factor:-

(Health status of the family/workers, Individual with chronic diseases, Reasons for going to health facilities

for treatment, Services and costs of health care, Coverage for health care costs, and Way to obtain money for

health care)

SHI Related Factors

(Premium afford ability, Scheme awareness and Benefit of the scheme)

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 Method and method…..Continued
Data collection tools
Self administered, structured, closed ended questionnaire.
Data quality control
 Assured through
 careful design of tools

 pretest
 training of the data collectors and supervisors
 close supervision of the data collectors
 proper handling of the data

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 Operational definitions
Willingness to pay:-The need to enroll and pay in SHI. Therefore, a
respondent will pay for SHI if the responses were 'yes' for both questions that
assess need and willingness to pay for SHI and if the respondent answers a
minimum of 3% of his salary to be paid for social health insurance premium
(Ethiopia U, 2021)

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Data processing and analysis

 Data entry into kobo toolbox and data analysis SPSS version 26

 Descriptive statistics for data summarization,

 Bivariate to identify associated factors and p<0.25 for selecting

candidate variables for multivariable analysis.
 p<0.05 to declare statistically significance and AOR with 95% CL
determined strength of association.

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 Method and method…..Continued
Ethical considerations
Ethical clearance was obtained from Africa medical college.

Verbal consent were obtained from each respondents.

Codes were used to assure confidentiality of the information.

Participation was based on their willingness.

Confidentiality of the information was assured.

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 Results and discussions
Socio-demographic characteristics

A total of 381 government employees participated in the study, with a response rate of

100%.

182 (47.8%) of the participants were in the age range of 31–40.

 203 (53.3%) of the participants were female. 244 (64.1%), were married

200 (52.5%) had a family size < 3.

238 (62.5%) had a degree in educational preparation

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 Result and discuss ---continued

Knowledge on Social health insurance related characteristics

326 (85.6%) heard about SHI.

132 (34.6%) heard from health professionals in health facilities.

267 (70.1%) of the respondents knew about social health insurance.

238(62.5%) of the respondents understood the service of social health

insurance, both inpatient and outpatient

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 Result and discuss ---continued

Health and health related factors characteristics

 166 (43.6%) rated their family health status as good.

 294 (78%) chose a health facility for sick family members that was physically accessible,

 313 (82.2%) chose a non-expensive place.

 63 (16.5%) experienced chronic diseases.

 184 (48.3%) had a history of illness in the last 3 months.

 344 (90.3%) were willing to cover their health problems with social health insurance.

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 Result and discuss ---continued
The Overall, 64.3%, 95% CI (59.5%–69.1%) of respondents were willing to pay the proposed premium
(3% of their monthly salary).

Willingness to pay for SHI

35.7% 64.3%
Yes No

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 Result and discuss ---continued

The study showed that over all Lower than the study conducted in
prevalence of SRB was 64.3%.  Mekelle City, 85.3% (28),

Consistent with a study conducted in, The possible explanation for this
 Cape Province, South Africa, 60% (29)
difference might be due to
 south-west Ethiopia, at 58% (30),

Higher than the study conducted in

differences in study period, study

 Addis Ababa 28.7% (14), area, study population, and also

 Mujja town at 37.6% (31) socio-demographic factors.
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 Result and discuss ---continued
On the multivariable logistic regression analysis

Suffering chronic illness[AOR: 2.46, 95% CI: (1.16, 5.21) ]

Illness in the past 3 months[AOR: 1.82; 95% CI (1.13, 2.94)]

Self and family health status[AOR፡ 4.23; 95% CI: (2.15, 8.32)]

Knowing health service coverage under SHI scheme[AOR: 2.24, 95%

CI:(1.31, 3.82)]

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Bivariate and Multivariate analysis of factors associated with willing to pay for SHI among public servants, Lideta sub-city, Addis Ababa, Ethiopia, 2023.

Variable WTP for SHI COR(95% CI) AOR(95% CI) P-value

Yes n (%) No n (%)
Sex
Male 115(30.2) 59(15.5) 1.15(0.56, 1.76) 0.82(0.51, 1.33) 0.423
Female 130(34.1) 77 (20.2) 1 1
Age category
< 40 99(26.0) 67(17.6) 1 1
> 40 146(38.6) 69(18.1) 1.43(0.94, 2.18) 1.31(0.82, 2.11) 0.261
Educational status
Diploma 40(10.5) 39(10.2) 1 1
Degree 162(42.5) 78(20.5) 2.03(1.21, 3.40) 1.29(0.71, 2.37 ) 0.406
Masters and above 43(11.3) 19(5.0) 2.21(1.10, 4.43 ) 1.54(0.69, 3.40) 0.290

Suffering chronic illness

Yes 53(13.9) 10(2.6) 3.48(1.71, 7.09) 2.46(1.16, 5.21) 0.019
No 192(50.4) 126(33.1) 1 1
Illness in the past 3 months
Yes 135(35.4) 48(12.6) 2.25(1.46, 3.47) 1.82(1.13, 2.94) 0.014
No 110(28.9) 88(23.1) 1 1
Self and family health status
Excellent 54(14.2) 56(14.7) 0.59(0.36, 0.91) 1.30(0.77, 2.21) 0.327
Very good 88(23.1) 17(4.7) 3.17(1.73, 5.81) 4.23(2.15, 8.32) 0.000
Good 103(27.0) 63(16.5) 1 1
Knowing health service coverage under SHI scheme
Yes 190(49.9) 77(20.2) 2.65(1.68, 4.16) 2.24(1.31, 3.82) 0.003
No 55(15.5) 59(14.4) 1 1

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 Result and discuss ---continued

The odds of willingness to pay for This might be due to the fact that
SHI were two times more likely public servants with chronic
among those who suffer from illnesses might have difficulty
chronic illness than those who don’t. living with current inflation and
These findings are supported by: such high health costs.
Mekelle City (Gidey MT, 2019)

Addis Ababa (Mekonne A, 2020)

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 Result and discuss ---continued

Public servants whose family This might be due to a family's

health status was very good were need to keep their family healthy.

4 times more willing to pay for

SHI than those whose family
health status was good
These findings are supported by:

Mujja town (Mekonnen Degie F, 2021),

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 Result and discuss ---continued
The odds of willingness to pay for SHI This might be due to the fact that
were two times higher among public those parents who infect in the
servants who got infections in the last 3
near future knew the cost of
months than those who weren’t infected
laboratory and medicine, and in
These findings are supported by:-
order to cover this high cost, they
Mekelle City (Gidey MT, 2019)
were willing to pay for SHI.
Addis Ababa (Mekonne A, 2020)

Mongolia(Batbold O, 2021)
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 Result and discuss ---continued
The odds of willingness to pay for SHI This might be due to the fact that
were two times higher among public
those who knew the services
servants who knew about health service
provided under the scheme were
coverage under the SHI scheme than those
easily willing to pay for social
who didn't.
health insurance.
These findings are supported by:

Mekelle City (Gidey MT, 2019)

Addis Ababa (Mekonne A, 2020)

28
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 Continued…

To Addis Ababa city government

 The city government should focus on designing pertinent policies (strategy) in order to

implement social health insurance program

 To researcher
 Researchers may use this reasrach as a baseline for further study to find other possible risk factors

for social health insurance program implementation

 Limitation of the study

 Since the study used Cross-sectional method .
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 Conclusion

Very good health status in the family,

Sick in the past 3 months,

 knew health services covered under SHI, and

Suffered from chronic illness were associated factors.

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 Acknowledgment

I would like to acknowledge

Africa medical college
My advisor
Data collectors
Participants
My family and friends

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 References

1. Robalino DA, Rawlings L, Walker I. 13 Building social protection and labour systems. Social protection in
developing countries: Reforming systems. 2013:149.

2. Organization WH. Everybody's business--strengthening health systems to improve health outcomes: WHO's
framework for action. 2007.

3. Organization WH. Report of the second WHO consultation on the global action plan for influenza vaccines
(GAP), Geneva, Switzerland, 12-14 July 2011. 2012.

4. Mekonen A, Seifu B, Hailu C, Atomsa A. Willingness to pay for social health insurance and associated factors
among health care providers in Addis Ababa, Ethiopia. BioMed research international. 2020;2020.

5. Batbold O, Pu C. Willingness to pay for private health insurance among workers with mandatory social health
insurance in Mongolia. International Journal for Equity in Health. 2021;20(1):1-14.

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 you
a n k
T h
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