Communities’ Willingness to Pay for Healthcare in Public Health Facilities of Nakasongola District, Uganda

Abstract

Poor countries continue to register decreasing revenue to finance health care amidst rising demand with consequently growing out of pocket expenditure on health exceeding 35% of the total health care expenditure; this scenario is observed in more than three quarter of Sub-Saharan African countries. For Uganda, the situation is even worse with about half of the national health expenditure financed from out of pocket despite tax-based national health services. In response, Uganda’s Ministry of Health has placed health insurance at centre of financing health care in the medium term. This paper examines willingness to pay for health care in line with the planned policy of Uganda. We evaluated: willingness to pay for the health care in public health facilities; household characteristics associated with willingness to pay; how much households were willing to pay; and the preferred mode of payment. Methods: We interviewed 376 household heads or their representatives in four sub-counties of Nakasongola district for willingness to pay for the current or improved quality of health care in public health facilities. In order to explore how much the households were willing to pay per capita member of household per annum, we employed the contingency valuation method using the ‘open-ended’ bidding game. Results: Majority, 56.7% (199) of the respondents were not willing to pay for health care in public health facilities at the current level of quality. Willingness to pay grew from 43.3% (152) to 83.5% (293) for improved quality of care in public health facilities. Major operations, in-patient therapeutic care and health facility deliveries in that order were the services communities were most willing to pay for if quality of care matched their expectation. The median willingness to pay was Ugandan shillings 4,888 ($1.56) (range 0-10,000 [$3.19]) and once-annual prepayment was preferred by majority of respondents. Female-household headship, high-level of education of household head and belonging to lower income quintiles were positively associated with willingness to pay. Conclusion: The communities in Nakasongola district are willing to pay for health care in public health facilities provided the quality of care is improved. Given the low median amount of willingness to pay and the fact that persons from poor households were more willing to pay, planners of Health Insurance programs should devise progressive premium calculation mechanisms and further plan for government subsidy in order to take care of the poor.