title: Eliciting preferences for social health insurance in Ethiopia: a discrete choice experiment.
abstract: As low-income countries are initiating health insurance schemes, Ethiopia is also planning to move away from out-of-pocket private payments to health insurance. The success of such a policy depends on understanding and predicting preferences of potential enrolees. This is because a scarce health care budget forces providers and consumers to make trade-offs between potential benefits within a health insurance. An assessment of preferences of potential enrolees can therefore add important information to optimal resource allocation in the design of health insurance. We used a discrete choice experiment to elicit preferences for social health insurance (SHI) among formal sector employees in Ethiopia. Respondents were presented with 18 binary hypothetical choices of SHI. Each insurance package was described by eight policy relevant attributes: premium, enrolment, exclusions, providers and coverage of inpatient services, outpatient services, drugs and tests. A mixed logit model was estimated to determine respondents' willingness to pay (WTP) for the different health insurance attributes. We also predicted probabilities of uptake for alternative SHI scenarios. Health insurance packages with 'no exclusions', 'public and private' providers, low rate of premium and full coverage of tests and drugs were highly valued and had greatest impact on the choices . Other things being equal, respondents were willing to contribute 1.52% (95% confidence interval (CI): 0.71, 2.32) of their salary to a SHI package with no service exclusions having public and private service providers. This is substantially lower than the proposed 3% premium in the draft SHI strategy. For the typical SHI package proposed by the SHI strategy at the time, the uptake probability was predicted to be 29% (95% CI: 0.25, 0.33). The low uptake probability and WTP for the proposed SHI package suggests considering preferences of the potential enrolees' in revisions of the draft SHI strategy for introduction of optimal SHI scheme would enhance acceptance.
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town. Anzio Road Observatory, Cape Town, 7925, South Africa g.amarech@gmail.com.|School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Amarech
authors.initials: A
authors.lastname: Obse
authors.affiliation: Health Economics Research Unit, Institute of Applied Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
authors.forename: Mandy
authors.initials: M
authors.lastname: Ryan
authors.affiliation: Health Economics Research Unit, Institute of Applied Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Heidenreich
authors.affiliation: Centre for Global Health, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
authors.affiliation: School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Damen
authors.initials: D
authors.lastname: Hailemariam
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003258:Consumer Behavior / Q000191:economics; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D005382:Financing, Personal; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration*; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration*; D008297:Male; D011203:Poverty; D040841:Resource Allocation / Q000191:economics; D011795:Surveys and Questionnaires
keywords: Discrete choice experiment; Ethiopia; health insurance; preferences; willingness to pay