IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v305y2022ics0277953622003690.html
   My bibliography  Save this article

How viable is social health insurance for financing health in Zambia? Results from a national willingness to pay survey

Author

Listed:
  • Kaonga, Oliver
  • Masiye, Felix
  • Kirigia, Joses Muthuri

Abstract

In an era of considerable uncertainty about future prospects for development assistance to fund major health programmes in Sub-Saharan Africa, social health insurance is increasingly being considered as an alternative mechanism for increasing financing health. However, empirical support for social health insurance in sub-Saharan Africa remains sparse. The main aim of this study was to examine the viability of increasing health financing through social health insurance in Zambia. The paper uses a large nationally representative household survey to estimate the expected mean and total willingness to pay for social health insurance. The revenue potential of social health insurance for health sector funding is assessed. The results show that despite a high level of public support for social health insurance, with 80% willing to join a social insurance scheme, the estimated mean monthly willingness-to-pay is relatively low at Zambian Kwacha 55 (US$8.8 in 2014 dollars) per household. The evidence presented in this paper suggests that the revenue potential of social health insurance would not be sufficient to fund major improvements in quality of care for insured members, let alone cross-subsidize benefits to non-members.

Suggested Citation

  • Kaonga, Oliver & Masiye, Felix & Kirigia, Joses Muthuri, 2022. "How viable is social health insurance for financing health in Zambia? Results from a national willingness to pay survey," Social Science & Medicine, Elsevier, vol. 305(C).
  • Handle: RePEc:eee:socmed:v:305:y:2022:i:c:s0277953622003690
    DOI: 10.1016/j.socscimed.2022.115063
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953622003690
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2022.115063?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. William C. Hsiao & R. Paul Shaw, 2007. "Social Health Insurance for Developing Nations," World Bank Publications - Books, The World Bank Group, number 6860, December.
    2. Yewande Kofoworola Ogundeji & Babatunde Akomolafe & Kelechi Ohiri & Nuhu Natie Butawa, 2019. "Factors influencing willingness and ability to pay for social health insurance in Nigeria," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-10, August.
    3. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517, May.
    4. Meheus, Filip & McIntyre, Di, 2017. "Fiscal space for domestic funding of health and other social services," Health Economics, Policy and Law, Cambridge University Press, vol. 12(2), pages 159-177, April.
    5. Carl Grekou & Romain Perez, 2014. "Child Mortality in sub-Saharan Africa: Why Public Health Spending Matters," EconomiX Working Papers 2014-28, University of Paris Nanterre, EconomiX.
    6. Hadley, Mary, 2011. "Does increase in utilisation rates alone indicate the success of a user fee removal policy? A qualitative case study from Zambia," Health Policy, Elsevier, vol. 103(2), pages 244-254.
    7. David Mark Dror, 2018. "Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 8, pages 151-168, World Scientific Publishing Co. Pte. Ltd..
    8. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    9. Leandro Medina & Mr. Andrew W Jonelis & Mehmet Cangul, 2017. "The Informal Economy in Sub-Saharan Africa: Size and Determinants," IMF Working Papers 2017/156, International Monetary Fund.
    10. Aurélia Lépine & Mylène Lagarde & Alexis Le Nestour, 2018. "How effective and fair is user fee removal? Evidence from Zambia using a pooled synthetic control," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 493-508, March.
    11. Kwabena Gyimah-Brempong, 2015. "Do African Countries Get Health from Health Aid?," Journal of African Development, African Finance and Economic Association (AFEA), vol. 17(2), pages 105-142.
    12. Felix Masiye & Collins Chansa, 2019. "Health Financing in Zambia," World Bank Publications - Reports 31786, The World Bank Group.
    13. Augustine Asante & Wilson S. K. Wasike & John E. Ataguba, 2020. "Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 743-746, December.
    14. Gustafsson-Wright, Emily & Asfaw, Abay & van der Gaag, Jacques, 2009. "Willingness to pay for health insurance: An analysis of the potential market for new low-cost health insurance products in Namibia," Social Science & Medicine, Elsevier, vol. 69(9), pages 1351-1359, November.
    15. Oliver Kaonga & Charles Banda & Felix Masiye, 2019. "Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-14, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Takondwa Mwase, 2021. "Health financing policy reforms for universal health coverage in eastern, central and southern Africa (ECSA)-health community region," Working Papers 179cherp, Centre for Health Economics, University of York.
    2. Acharya, Arnab & Vellakkal, Sukumar & Taylor Fiona & Masset Edoardo & Satija, Ambika & Burke, Margaret & Ebrahim, Shah, 2013. "The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review," Policy Research Working Paper Series 6324, The World Bank.
    3. Wagstaff, Adam, 2009. "Social health insurance vs. tax-financed health systems - evidence from the OECD," Policy Research Working Paper Series 4821, The World Bank.
    4. Liu, Kai & Wu, Qiaobing & Liu, Junqiang, 2014. "Examining the association between social health insurance participation and patients' out-of-pocket payments in China: The role of institutional arrangement," Social Science & Medicine, Elsevier, vol. 113(C), pages 95-103.
    5. World Bank, 2014. "Assessment of Health Financing Options : Papua New Guinea," World Bank Publications - Reports 21118, The World Bank Group.
    6. Renard, Yohan, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," World Development, Elsevier, vol. 156(C).
    7. Monica Ewomazino Akokuwebe & Erhabor Sunday Idemudia, 2022. "A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys," IJERPH, MDPI, vol. 19(3), pages 1-26, February.
    8. Liu, Jun-Qiang, 2011. "Dynamics of social health insurance development: Examining the determinants of Chinese basic health insurance coverage with panel data," Social Science & Medicine, Elsevier, vol. 73(4), pages 550-558, August.
    9. Peter Binyaruka & Josephine Borghi, 2022. "An equity analysis on the household costs of accessing and utilising maternal and child health care services in Tanzania," Health Economics Review, Springer, vol. 12(1), pages 1-15, December.
    10. Oliver Kaonga & Charles Banda & Felix Masiye, 2019. "Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-14, April.
    11. Soeb Md. Shoayeb Noman, 2021. "Government Employees of Bangladesh and their Willingness to Pay for Social Health Insurance," Business and Economic Research, Macrothink Institute, vol. 11(2), pages 207-217, June.
    12. Aurélia Lépine & Mylène Lagarde & Alexis Le Nestour, 2018. "How effective and fair is user fee removal? Evidence from Zambia using a pooled synthetic control," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 493-508, March.
    13. Jean-Louis Arcand & Linguère M'Baye, 2013. "Braving the waves: the role of time and risk preferences in illegal migration from Senegal," CERDI Working papers halshs-00855937, HAL.
    14. de Menil, Victoria & Knapp, Martin & McDaid, David & Njenga, Frank Gitau, 2014. "Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance," LSE Research Online Documents on Economics 56444, London School of Economics and Political Science, LSE Library.
    15. Micheal Kofi Boachie & K. Ramu & Tatjana Põlajeva, 2018. "Public Health Expenditures and Health Outcomes: New Evidence from Ghana," Economies, MDPI, vol. 6(4), pages 1-25, October.
    16. Jean-Louis Arcand & Linguère M'Baye, 2011. "Braving the waves: The economics of clandestine migration from Africa," CERDI Working papers halshs-00575606, HAL.
    17. Dayashankar Maurya, 2019. "Understanding public health insurance in India: A design perspective," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1633-1650, October.
    18. Nadine Muller & Shannon A McMahon & Jan-Walter De Neve & Alexej Funke & Till Bärnighausen & Elsa N Rajemison & Etienne Lacroze & Julius V Emmrich & Samuel Knauss, 2020. "Facilitators and barriers to the implementation of a Mobile Health Wallet for pregnancy-related health care: A qualitative study of stakeholders’ perceptions in Madagascar," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    19. Steven F. Koch, 2017. "Does the Equivalence Scale Matter? Equivalence and Out-of-Pocket Payments," Working Papers 687, Economic Research Southern Africa.
    20. Zhiyuan Hou & Ellen Van de Poel & Eddy Van Doorslaer & Baorong Yu & Qingyue Meng, 2014. "Effects Of Ncms On Access To Care And Financial Protection In China," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 917-934, August.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:305:y:2022:i:c:s0277953622003690. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.