Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

Area of Science:

• Health Economics
• Public Health Policy

Background:

• Healthcare access in low- and middle-income countries (LMICs) heavily relies on out-of-pocket spending (OOPS).
• Achieving universal health insurance coverage necessitates substantial funding, raising questions about individuals' and households' willingness to pay (WTP).

Purpose of the Study:

• To systematically review and synthesize evidence on individual and household WTP for health insurance in LMICs.
• To identify factors influencing WTP for health insurance in these regions.

Main Methods:

• Systematic literature search up to February 2016.
• Inclusion of studies on individual or household WTP for health insurance.
• Meta-analysis to calculate mean WTP as a percentage of GDP per capita and adjusted net national income per capita.
• Vote-counting to identify influencing variables.

Main Results:

• 16 studies from ten countries were included.
• Mean individual WTP was 1.18% of GDP per capita; mean household WTP was 1.82%.
• Higher WTP correlated with increased family size, education, and income; lower WTP correlated with increased age.

Conclusions:

• Household WTP for health insurance in LMICs is less than 2% of GDP per capita.
• Governments should not depend primarily on household premiums for financing universal health coverage.
• Increased government fiscal capacity through alternative sources is crucial for an equitable healthcare system.