Le consentement des ménages ruraux à payer une prime d'assurance maladie en Côte d'Ivoire

Since the implementation of the recovery cost policy in developing countries health sectors, the recourse of health care has decreased. This is why, some countries like Côte d?Ivoire decided to settle a social health insurance scheme to improve the access of health services. Generally, the decision to contribute for a health insurance has two parts. People can decide first to contribute or not, and secondly, people can decide which level of amount to contribute. The main objective of this paper is to compare such decision process and examine whether it has an impact on the willingness to pay (WTP) for a universal health insurance scheme that is to be implemented in Côte d?Ivoire. The study is based on a rural household survey conducted in southern-eastern Côte d?Ivoire and included 367 respondents. The willingness to pay is estimated through a contingent valuation method and the determinants of the WTP are obtained by performing two econometric models : a censored normal Tobit model (simultaneous decision) and a generalized Tobit model (sequential decision). We found a mean annual WTP of CFA Francs, 9,569 while the median WTP was CFA Francs, 5.000. The econometric estimations show that the two models give different results. In the censored normal Tobit results, the household?s income is not significant while in the generalized Tobit model the household income is a significant determinant. This result suggests that a methodology that ignores the decision process of the household can give misleading policy advices.