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A Comparative Study of Household Willingness to Pay for Community-Based Health Insurance in Urban and Rural Local Government Areas in Lagos State

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A Comparative Study of Household Willingness to Pay for Community-Based Health Insurance in Urban and Rural Local Government Areas in Lagos State A COMPARATIVE STUDY OF HOUSEHOLD WILLINGNESS TO PAY FOR COMMUNITY-BASED HEALTH INSURANCE IN URBAN AND RURAL LOCAL GOVERNMENT AREAS IN LAGOS STATE SUBMITTED BY DR AGBO IJEOMA NKIRUKA EZIOMA DEPARTMENT OF COMMUNITY HEALTH LAGOS UNIVERSITY TEACHING HOSPITAL, IDI-ARABA, LAGOS TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FINAL FELLOWSHIP OF THE MEDICAL COLLEGE IN PUBLIC HEALTH (FMCPH) NOVEMBER 2014 DECLARATION I declare that this Part II Dissertation titled “A comparative study of household willingness to pay for community based health insurance in Urban and Rural LGAs in Lagos state” is my original and individual work. It was done under appropriate supervision. It has not been submitted in part or in full for any other examination. ----------------------------------------------- ------------------- Dr Ijeoma N.E. Agbo Date Department of Community Health Lagos University Teaching Hospital Idi-Araba, Lagos, ii DEDICATION This project is dedicated to God the Almighty iii CERTIFICATION This is to certify that this dissertation “A comparative study of household willingness to pay for community based health insurance in Urban and Rural LGAs in Lagos state” was written by Dr. Ijeoma Nkiruka Ezioma Agbo of the Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, under my supervision. ------------------------------------------ ------------------------- Supervisor Date Prof. A.T. Onajole Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos ----------------------------------------- ----------------------- Prof. A. T. Onajole Date Head of Department Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos iv ACKNOWLEDGEMENT I would like to express my profound gratitude to the Almighty God for his grace in seeing me thus far and bringing this project to this end. I am deeply grateful to my supervisor, Prof A. T. Onajole for his time, patience, guidance and the direction in supervising this work. Thank you Sir. I thank Dr Ogunnowo for his attention to detail and his continued constructive critique at every stage of this work. I also appreciate Dr (Mrs) K.T. Odeyemi and the entire staff of Community Health department for the training I have received from them. To Drs Ariyibi, Okwor, Ikpeekha and my colleagues at the department, I say a big thank you for your contributions and advice on this project. Thanks to the Medical officers of Health in Surulere and Ikorodu LGAs for putting up with my numerous demands. I am most grateful. Thanks to Chika for helping with my data entry and your support in this work. To my parents, Prof and Mrs G.C Onyedim, thanks for believing in me. To my husband Chijioke and residency children, Nkemka, Kambinachi and Tobenna, despite my doubts you always see the best in me and for this I am grateful. v TABLE OF CONTENTS DECLARATION...................................................................................................................... ii DEDICATION........................................................................................................................ iii CERTIFICATION .................................................................................................................. iv ACKNOWLEDGEMENT ....................................................................................................... v LIST OF TABLES ............................................................................................................... viii LIST OF ABBREVIATIONS ................................................................................................ xi SUMMARY ............................................................................................................................ xii CHAPTER ONE .................................................................................................................... 1 INTRODUCTION .................................................................................................................. 1 CHAPTER TWO.................................................................................................................. 10 LITERATURE REVIEW ..................................................................................................... 10 CHAPTER THREE .............................................................................................................. 32 METHODOLOGY ............................................................................................................... 32 CHAPTER FOUR ................................................................................................................ 44 RESULTS............................................................................................................................. 44 CHAPTER FIVE .................................................................................................................. 93 DISCUSSION ...................................................................................................................... 93 CHAPTER SIX .................................................................................................................. 106 CONCLUSION .................................................................................................................. 106 RECOMMENDATIONS....................................................................................................106 vi REFERENCES ................................................................................................................... 108 APPENDIX A: Questionnaire APPENDIX B: Ethical Clearance vii LIST OF TABLES Pages Table 1: Demographic characteristics of respondents ............................................................. 44 Table 2: Socio-economic characteristics of respondents ......................................................... 44 Table 3: Health seeking behaviour of most recent illness in the household ............................ 48 Table 4: Amount spent on treatment by household head on most recent illness in the household in last 3 months ....................................................................................................... 50 Table 5: Household heads payment mechanisms for treatment of most recent illness in the household ................................................................................................................................. 52 Table 6: Awareness of health insurance among the respondents ............................................ 54 Table 7: Perception of community based health insurance among the respondents ................ 56 Table 8: Level of perception of respondents to community based health insurance ............... 58 Table 9: Respondent’s acceptance of community based health insurance as a strategy for paying for their health .............................................................................................................. 59 Table10: Level of acceptance of community based health insurance among the respondents in the urban and rural LGA .......................................................................................................... 60 Table 11: Reasons for non-acceptance of community based health insurance among respondents .............................................................................................................................. 61 Table 12: Respondents willingness to pay for a hypothetical CBHI package for their household ................................................................................................................................. 62 Table 13: Respondents reasons for unwillingness to pay for the hypothetical community based health insurance package ............................................................................................... 63 Table 14: Respondents willingness to pay bids of 500,450 and 350 naira as premium for CBHI for individual enrolees per month ................................................................................. 64 viii Table 15: The maximum amount respondents were willing to pay as premium for individual enrolees per month ................................................................................................................... 65 Table 16: The premium all respondents were willing to pay for the scheme for individual enrolee per month in case of inflation...................................................................................... 67 Table 17: Respondents willingness to pay start, second and third bids (900, 850 and 750 naira) as premium for their household in the proposed scheme .............................................. 68 Table 18: Maximum amount respondents were willing to pay (those that refused the bids) for household ................................................................................................................................. 70 Table 19: The premium all respondents were willing to pay for their household per month in case of inflation ........................................................................................................................ 72 Table 20: Association between respondents’ gender and their willingness to pay for CBHI . 73 Table 21: Association between the age groups of respondents and their willingness to pay for CBHI ........................................................................................................................................ 74 Table
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