Association Between Socioeconomic Status and Willingness to Pay for Medical Care Among Government School Teachers in Addis Ababa
Science Journal of Public Health
Volume 3, Issue 5, September 2015, Pages: 677-685
Received: Jul. 5, 2015; Accepted: Jul. 16, 2015; Published: Jul. 28, 2015
Views 4421      Downloads 132
Authors
Kumlachew Abate, United Nations High Commissioner for Refugees, Public Health Section, Juba, South Sudan
Alemayehu Worku, Department of Public Health, Addis Ababa University, Department of Biostatics, Addis Ababa, Ethiopia
Shimels Hussien, World Health Organization, MCH/Nutrition Cluster, Addis Ababa, Ethiopia
Ayalew Aklilu, Tulane International-Ethiopia, Addis Ababa, Ethiopia
Article Tools
Follow on us
Abstract
In low income countries households are the principal health financing agents. Their expense goes not without shrinking the basic consumptions of the household. This cost is not even enough to avert the consequences either. As a consequence it perpetuates the vicious cycle between sickness and poverty. Control of diseases or their outcome will depend on socioeconomic determinants. Understanding what affects willingness-to-pay (WTP) for medical care is very important to design choices about the allocation of scarce resources. The objective of this study was to assess the association between socioeconomic status and WTP for medical care among government school teachers in Addis Ababa. A cross sectional survey methodology was employed and a structured questionnaire was administered to 847 government school teachers between January to March 2011. The sample was generated by a two-stage probability proportional to size sampling (PPS) method. A dichotomous choice contingent valuation method (CVM) in the single bound formulation was used to elicit a “yes” or “no” answer by respondents when asked if they are WTP a given bid for medical care. Three hypothetical case scenarios: common cold (CC), glaucoma (BD) and heart attack (HAT) were designated. Both descriptive and analytic statistics were used to analyze the data. The degree and strength of association between the explanatory variables and willingness to pay were evaluated by logistic regression. Generally more respondents were WTP for CC, BD and HAT in government than private facilities. In government facilities WTP for CC and BD did not vary with socioeconomic status. However WTP for HAT was lower in the low income group and educational status. In private facilities WTP for CC varied with land ownership only.WTP for both BD and HAT was higher in those with better income and who own land. Educational level, proxy indicators of wealth, income level, lower medical care costs and seriousness of illness were found to positively influence the WTP for medical care. Improving employment benefits and establishing a mechanism to help raise the ability to pay are commendable policy measures.
Keywords
Willingness to Pay, Contingent Valuation Method, Medical Care
To cite this article
Kumlachew Abate, Alemayehu Worku, Shimels Hussien, Ayalew Aklilu, Association Between Socioeconomic Status and Willingness to Pay for Medical Care Among Government School Teachers in Addis Ababa, Science Journal of Public Health. Vol. 3, No. 5, 2015, pp. 677-685. doi: 10.11648/j.sjph.20150305.23
References
[1]
Willingness to pay to sustain and expand National Health Insurance services in Taiwan. Taiwan:instituteofpublichealth;2008.Available from http://www.biomedcentral.com/1472-6963/8/261
[2]
Karen G,James R. Willingness to pay surveys for setting prices for reproductive health products and services a user’s manual;2004.
[3]
Calia P,Strazzera E. Bias and efficiency of single and double bound models for CV studies: A Monte Carlo Anlaysis. Applied Economics 2000;32(10):1329-1326
[4]
Willingness and ability to pay for artemisinin-based combination therapy in rural Tanzania.Tanzania: Muhimbili University College of Health Sciences Department of Parasitology and Entomology; 2008.
[5]
Available from http://www.malariajournal.com/content/7/1/227
[6]
Olsenab J, Kidholmc K, Donaldsond C, Shackleye P. Willingness to pay for public health care: a comparison of two approaches. J.healthpol.2004;70 (2):217_228
[7]
Willingness to pay to assess patient preferences for therapy in a Canadian setting.Canada:Pharmaceutical Sciences Clinical Service Unit, Vancouver Hospital and Health Sciences Centre, Vancouver British Columbia;2004.Available from http://www.biomedcentral.com/1472-6963/5/43
[8]
Willingness to pay for social health insurance among informal sector workers in Wuhan, China: a contingent valuation study.China: Huazhong University of Technology and Science;2007.Available from http://www.biomedcentral.com/1472-6963/7/114
[9]
Arrow K, Solow R, Portney PR,Leamer EE,Radner R,Schuman H, editors.Report of the NOAA Panel on contingent valuation;1993.
[10]
Yu D, Souteyrand Y, Banda MA, Kaufman J, Perriëns JH. Investment in HIV/AIDS programs: does it help strengthen health systems in developing countries?. Global Health 2008; 16: 4-8.
[11]
Cissé B, Luchini S, Moatti JP. Progressivity and horizontal equity in health care finance and delivery: What about Africa?.Health Policy 2007; 80: 51-68
[12]
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003; 362: 111_117.
[13]
Preker AS, Langenbrunner J. Spending wisely: buying health services for the poor. Washington, DC: The World Bank, 2005.
[14]
Habbani K, Groot W, Jelovac I. Do free-of-charge public health services impede cost recovery policies in Khartoum state, Sudan? Eastern Mediterranean health journal 2007; 13(4) :939-952
[15]
Ashagre G,Abebe Y. Free health care provision and its financial implications in Gondar town ,nothwest Ethiopia. Ethiop.J.Health Dev.2004;18(2):125_129
[16]
Wolde M,Jirra C,Tegegne A. An assessment of the free health care provision system in Jimma town ,southwest Ethiopia. Ethiop.J.Health Dev.2005;19(3):188_194
[17]
Russel S,Abdella K.25. Too poor to be sick: Coping with the cost of illness in East Hararghe,Ethiopia.17 Grove Lane;2002 Coping with the costs of illness in East Hararghe, Ethiopia.
[18]
Marmot M,Bell R .Action on health disparities in the United States: commission on social determinants of health; JAMA. 2009;301(11):1169-1171
[19]
Doorslaer VE, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC,et al. Paying out-of-pocket for health care in Asia: catastrophic and poverty impact. Health Economics 2007; 16(11): 1159–1184
[20]
Russell S. The economic burden of illness for households in developing countries: a review of studies focusing on Malaria, Tuberculosis and Human Immunodeficiency Virus/Acquired Immunodeficiency syndrome. Am J Trop Med Hyg 2004;71 (2), 147-155.
[21]
Willingness to pay for rapid diagnostic tests for the diagnosis and treatment of malaria in southeast Nigeria: ex post and ex ante; 2010.Available from: http://www.equityhealthj.com/content/9/1/1
[22]
Robinson R. Economic Evaluation and Health Care: cost benefit analysis. BMJ 1993;307:924_6
[23]
Danis M,Lovett F,Sabik L,Adikes K,Cheng G,Aomo T.Low income employee’s choices regarding employment benefits aimed at improving the socioeconomic determinants of health.Am J Public Health 2007;97(9):1650-1657
[24]
Bala M, Mauskopf J, Wood L. Willingness to Pay as a Measure of Health Benefits. Pharmacoeconomics 1999; 15 (1): 9-18.
[25]
Hansen D. Willingness to Pay for a QALY Theoretical and Methodological Issues. Pharmacoeconomics 2005; 23 (5): 423-432
[26]
Olsen J, Smith R. Theory Versus Practice: A Review Of ‘WILLINGNESS-TO-PAY’ In Health and Health Care. Health Econ.2001; 10: 39–52.
[27]
Willingness to pay for health care services in common cold, retinal detachment , and myocardiac infarction: an internet survey in Japan. Japan , University of Tokyo Hospital;2006.Available from :http://www.biomedcentral.com/1472-6963/6/12
[28]
Ternent L, McNamee P,Newlands D, Belemsaga D,Gbangou A, Cross S. Willingness to Pay for Maternal Health Outcomes Are Women Willing to Pay More than Men? Appl Health Econ Health Policy 2010; 8 (2): 99-109.
[29]
Mendoza UR. Why do the poor pay more? Exploring the poverty penalty concept. Journal of Int.dvt 2008;23(1):1-28
[30]
Koford CB.Public Public Budget Choices and Private Willingness to Pay. Budgeting & Finance 2010;30(2):47-68.
[31]
Legesse Y, Tegegn A, Belachew T,Tushune K. Households willingness to pay for long-lasting insecticide treated nets in three urban communities of Assosa zone, Western Ethiopia. Ethiop Med J 2007; 45(4):353-362
[32]
Hagos D,Mekonen A, Gebreegziabher Z. Household willingness to pay for improved solid waste management: the case of Mekelle City, Ethiopia.
[33]
Asfaw A, Braun VJ. Can community health insurance schemes shield the poor against the downside health effects of economic reforms? The case of rural Ethiopia. Health Policy 2004; 70 (1) :97–108.
[34]
Asfaw A, Braun VJ .Innovations in health care financing, new evidence on the prospect of community health insurance schemes in the rural areas of Ethiopia. International Journal of Health Care Finance and Economics 2005; 5: 241–253.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186