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Estimating willingness to pay for public health insurance while accounting for protest responses: A further step towards universal health coverage in Tunisia?

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  • Mohammad Abu-Zaineh

    (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique, SMPM - Faculty of Medical and Paramedical Sciences, School of Public Administration and Development Economics, Doha Institute for Graduate Studies)

  • Olivier Chanel

    (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)

  • Khaled Makhloufi

    (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale)

Abstract

Introduction: Developing countries face major challenges in implementing universal health coverage (UHC): a widespread informal sector, general discontent with rising economic insecurity and inequality and the rollback of state and public welfare. Under such conditions, estimating the demand for a health insurance scheme (HIS) on voluntary basis can be of interest to accelerate the progress of UHC-oriented reforms. However, a major challenge that needs to be addressed in such context is related to protest attitudes that may reflect, inter alia, a null valuation of the expected utility or unexpressed demand. Methods: We propose to tackle this by applying a contingent valuation survey to a non-healthcare-covered Tunisian sample vis-à-vis joining and paying for a formal HIS. Our design pays particular attention to identifying the nature of the willingness-to-pay (WTP) values obtained, distinguishing genuine null values from protest values. To correct for potential selection issues arising from protest answers, we estimate an ordered-Probit-selection model and compare it with the standard Tobit and Heckman sample selection models. Results: Our results support the presence of self-selection and, by predicting protesters' WTP, allow the "true" sample mean WTP to be computed. This appears to be about 14% higher than the elicited mean WTP. Conclusion: The WTP of the poorest non-covered respondents represents about one and a half times the current contributions of the poorest formal sector enrolees, suggesting that voluntary participation in the formal HIS is feasible.

Suggested Citation

  • Mohammad Abu-Zaineh & Olivier Chanel & Khaled Makhloufi, 2022. "Estimating willingness to pay for public health insurance while accounting for protest responses: A further step towards universal health coverage in Tunisia?," Post-Print hal-03684923, HAL.
    • Handle: RePEc:hal:journl:hal-03684923
    DOI: 10.1002/hpm.3505
    Note: View the original document on HAL open archive server: https://amu.hal.science/hal-03684923
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    Keywords

    contingent valuation; protest answers; self-selection; universal health coverage; willingness-to-pay;
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