IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v8y2018i1d10.1186_s13561-018-0208-4.html
   My bibliography  Save this article

Extension of mandatory health insurance to informal sector workers in Togo

Author

Listed:
  • Dosse Mawussi Djahini-Afawoubo

    (University of Lomé (Togo))

  • Esso-Hanam Atake

    (University of Lomé (Togo))

Abstract

Background About 90.4% of Togolese workers operate in the informal sector and account for between 20 and 30% of Togo’s Gross Domestic Product. Despite their importance in the Togolese economy, informal sector workers (ISW) do not have a health insurance scheme. This paper aims to estimate the willingness-to-pay (WTP) of ISW in order to have access to Mandatory Health Insurance (MHI), and to analyze the main determinants of WTP. Methods This study used data from the Community-Based Monitoring System (CBMS) project implemented in 2015 by the Partnership for Economic Policy (PEP). It focusses on 4,296 ISW (2,374 in urban areas and 1,922 in rural areas, respectively). The contingent valuation method was used to determine the WTP for the MHI while the Tobit model is used to analyze its determinants. Results and discussion Findings indicate that about 92% of ISW agreed to have access to MHI, like for formal sector workers. Overall, ISW are willing to pay 2,569 FCFA (USD 4.7) per month. ISW in the poorest quintiles are willing to allocate a higher proportion of their income (15%) to the premium than the richest quintiles (2.5%). Generally, women are more interested in MHI than men, although men are willing to pay higher premiums (3,168.9 FCFA or USD 5.8) than women (2,077 FCFA or USD 3.8). Women’s lower WTP can be explained by their low levels of education and income, and a lack of employment opportunities compared to men. The gender of the head of the household, the size of the household and the education and income levels are the main determinants of WTP. Conclusion We conclude that it is possible to extend MHI to ISW as long as their premiums are subsidized. The annual subsidy is estimated at 4.1% of the state current general budget or 96% of the health sector budget. In setting the premium, policy makers should take into account the MHI benefits package, subsidies from the government, and information about the WTP. It is important to emphasize that resource mobilization and management, as well as health services delivery, would be effective only in a context of improved governance.

Suggested Citation

  • Dosse Mawussi Djahini-Afawoubo & Esso-Hanam Atake, 2018. "Extension of mandatory health insurance to informal sector workers in Togo," Health Economics Review, Springer, vol. 8(1), pages 1-13, December.
    • Handle: RePEc:spr:hecrev:v:8:y:2018:i:1:d:10.1186_s13561-018-0208-4
    DOI: 10.1186/s13561-018-0208-4
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-018-0208-4
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-018-0208-4?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
    ---><---

    References listed on IDEAS

    as
    1. Chetty, Raj & Looney, Adam, 2006. "Consumption smoothing and the welfare consequences of social insurance in developing economies," Journal of Public Economics, Elsevier, vol. 90(12), pages 2351-2356, December.
    2. Hermann Donfouet & Ephias Makaudze & Pierre-Alexandre Mahieu & Eric Malin, 2011. "The determinants of the willingness-to-pay for community-based prepayment scheme in rural Cameroon," International Journal of Health Economics and Management, Springer, vol. 11(3), pages 209-220, September.
    3. Dong, Hengjin & Kouyate, Bocar & Snow, Rachel & Mugisha, Frederick & Sauerborn, Rainer, 2003. "Gender's effect on willingness-to-pay for community-based insurance in Burkina Faso," Health Policy, Elsevier, vol. 64(2), pages 153-162, May.
    4. Currie, Janet & Madrian, Brigitte C., 1999. "Health, health insurance and the labor market," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 3, chapter 50, pages 3309-3416, Elsevier.
    5. Esso-Hanam Atake, 2017. "Sustaining Gains in Health Programs: Technical Efficiency and its Determinants in Malaria Programs in Sub-Saharan Africa," Applied Health Economics and Health Policy, Springer, vol. 15(2), pages 249-259, April.
    6. De Allegri, Manuela & Sanon, Mamadou & Bridges, John & Sauerborn, Rainer, 2006. "Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa," Health Policy, Elsevier, vol. 76(1), pages 58-71, March.
    7. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    8. Yawo A. Noglo & Komivi Afawubo, 2017. "2011-2015: an illustration based on the decomposition of the Gini coefficient using the Shapley value approach," Economics Bulletin, AccessEcon, vol. 37(4), pages 2602-2615.
    9. Chaudhuri, Anoshua & Roy, Kakoli, 2008. "Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002," Health Policy, Elsevier, vol. 88(1), pages 38-48, October.
    10. Frank Gyimah Sackey & Peter N. Amponsah, 2017. "Willingness to accept capitation payment system under the Ghana National Health Insurance Policy: do income levels matter?," Health Economics Review, Springer, vol. 7(1), pages 1-13, December.
    11. Dong, Hengjin & Mugisha, Frederick & Gbangou, Adjima & Kouyate, Bocar & Sauerborn, Rainer, 2004. "The feasibility of community-based health insurance in Burkina Faso," Health Policy, Elsevier, vol. 69(1), pages 45-53, July.
    12. Akoété Ega Agbodji & Yélé Maweki Batana & Dénis Ouedraogo, 2015. "Gender inequality in multidimensional welfare deprivation in West Africa," International Journal of Social Economics, Emerald Group Publishing Limited, vol. 42(11), pages 980-1004, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Dossè Mawussi DJAHINI-AFAWOUBO, 2023. "Niveau d’éducation et probabilité d’être employé dans le secteur informel au Togo," Region et Developpement, Region et Developpement, LEAD, Universite du Sud - Toulon Var, vol. 57, pages 29-48.
    2. Djahini-Afawoubo, Dossè Mawussi & Couchoro, Mawuli Kodjovi & Atchi, Fambari Kokou, 2023. "Does mobile money contribute to reducing multidimensional poverty?," Technological Forecasting and Social Change, Elsevier, vol. 187(C).

    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. Qun Wang & Yi Zhou & Xinrui Ding & Xiaohua Ying, 2017. "Demand for Long-Term Care Insurance in China," IJERPH, MDPI, vol. 15(1), pages 1-15, December.
    2. Liu, Kai, 2016. "Insuring against health shocks: Health insurance and household choices," Journal of Health Economics, Elsevier, vol. 46(C), pages 16-32.
    3. Donfouet, Hermann Pythagore Pierre & Mohamed, Shukri F. & Otieno, Peter & Wambiya, Elvis & Mutua, Martin Kavao & Danaei, Goodarz, 2020. "Economic valuation of setting up a social health enterprise in urban poor-resource setting in Kenya," Social Science & Medicine, Elsevier, vol. 266(C).
    4. William Fonta & H. Ichoku & Jane Kabubo-Mariara, 2010. "The effect of protest zeros on estimates of willingness to pay in healthcare contingent valuation analysis," Applied Health Economics and Health Policy, Springer, vol. 8(4), pages 225-237, July.
    5. Yiding Yue & Jinyou Zou, 2014. "The Role of Wealth and Health in Insurance Choice: Bivariate Probit Analysis in China," Mathematical Problems in Engineering, Hindawi, vol. 2014, pages 1-9, March.
    6. Stephen K.O. Duku & Edward Nketiah-Amponsahd & Christine J. Fenenga & Daniel K. Arhinful & Wendy (W.) Janssens & Menno (M.) Pradhan, 2018. "The Effect of Community Engagement on Healthcare Utilization and Health Insurance Enrolment in Ghana Results from a Randomized Experiment," Tinbergen Institute Discussion Papers 18-017/V, Tinbergen Institute.
    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. Laura Ternent & Paul McNamee & David Newlands & Danielle Belemsaga & Adjima Gbangou & Suzanne Cross, 2010. "Willingness to pay for maternal health outcomes," Applied Health Economics and Health Policy, Springer, vol. 8(2), pages 99-109, March.
    9. David Mark Dror, 2018. "What Factors Affect Voluntary Uptake of Community-based Health Insurance Schemes in Lowand Middle-Income Countries? A Systematic Review and Meta-Analysis," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 14, pages 271-306, World Scientific Publishing Co. Pte. Ltd..
    10. Mohd Zuhair & Ram Babu Roy, 2022. "Eliciting relative preferences for the attributes of health insurance schemes among rural consumers in India," International Journal of Health Economics and Management, Springer, vol. 22(4), pages 443-458, December.
    11. Gnawali, Devendra Prasad & Pokhrel, Subhash & Sié, Ali & Sanon, Mamadou & De Allegri, Manuela & Souares, Aurélia & Dong, Hengjin & Sauerborn, Rainer, 2009. "The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso," Health Policy, Elsevier, vol. 90(2-3), pages 214-222, May.
    12. John E. Ataguba & Hyacinth E. Ichoku & William M. Fonta, 2008. "Estimating the willingness to pay for community healthcare insurance in rural Nigeria," Working Papers PMMA 2008-10, PEP-PMMA.
    13. Hermann Donfouet & Pierre-Alexandre Mahieu & Eric Malin, 2013. "Using respondents’ uncertainty scores to mitigate hypothetical bias in community-based health insurance studies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 277-285, April.
    14. Dong, Hengjin & De Allegri, Manuela & Gnawali, Devendra & Souares, Aurélia & Sauerborn, Rainer, 2009. "Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso," Health Policy, Elsevier, vol. 92(2-3), pages 174-179, October.
    15. Sibylle Gerstl & Justin Sauter & Joseph Kasanda & Alfred Kinzelbach, 2013. "Who Can Afford Health Care? Evaluating the Socio-Economic Conditions and the Ability to Contribute to Health Care in a Post-Conflict Area in DR Congo," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    16. Dixon, Jenna & Luginaah, Isaac & Mkandawire, Paul, 2014. "The National Health Insurance Scheme in Ghana's Upper West Region: A gendered perspective of insurance acquisition in a resource-poor setting," Social Science & Medicine, Elsevier, vol. 122(C), pages 103-112.
    17. David Mark Dror, 2018. "Health Insurance Benefit Packages Prioritized by Low-Income Clients in India: Three Criteria to Estimate Effectiveness of Choice," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 13, pages 253-270, World Scientific Publishing Co. Pte. Ltd..
    18. Abiiro, Gilbert Abotisem & Torbica, Aleksandra & Kwalamasa, Kassim & De Allegri, Manuela, 2014. "Eliciting community preferences for complementary micro health insurance: A discrete choice experiment in rural Malawi," Social Science & Medicine, Elsevier, vol. 120(C), pages 160-168.
    19. De Allegri, Manuela & Sanon, Mamadou & Sauerborn, Rainer, 2006. ""To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa," Social Science & Medicine, Elsevier, vol. 62(6), pages 1520-1527, March.
    20. Manoj Mohanan, 2008. "Consumption Smoothing and Household Responses: Evidence from Random Exogenous Health Shocks," CID Working Papers 23, Center for International Development at Harvard University.

    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:spr:hecrev:v:8:y:2018:i:1:d:10.1186_s13561-018-0208-4. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    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.