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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?

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.
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https://hal-amu.archives-ouvertes.fr/hal-03684923
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Submitted on : Wednesday, June 1, 2022 - 5:00:25 PM
Last modification on : Thursday, June 23, 2022 - 3:55:57 PM

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Health Planning Management - 2...
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Mohammad Abu‐zaineh, Olivier Chanel, Khaled Makhloufi. Estimating willingness to pay for public health insurance while accounting for protest responses: A further step towards universal health coverage in Tunisia?. International Journal of Health Planning and Management, Wiley, In press, ⟨10.1002/hpm.3505⟩. ⟨hal-03684923⟩

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