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

Mohammad Abu-Zaineh, Olivier Chanel and Khaled Makhloufi
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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

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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.

Keywords: contingent valuation; protest answers; self-selection; universal health coverage; willingness-to-pay (search for similar items in EconPapers)
Date: 2022-09
New Economics Papers: this item is included in nep-ara, nep-dcm and nep-upt
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Published in International Journal of Health Planning and Management, 2022, 37 (5), pp.2809-2821. ⟨10.1002/hpm.3505⟩

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Journal Article: Estimating willingness to pay for public health insurance while accounting for protest responses: A further step towards universal health coverage in Tunisia? (2022)
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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03684923

DOI: 10.1002/hpm.3505

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