Willingness To Pay For Community-based Health Insurance Among Urban Households Of Cameroon

The risks associated with direct health spending are very high in Cameroon,where almost all household income is spent on health care.In 2014,only 3%of the population was covered by a partial health insurance mechanism.There is no real social security in Cameroon because of the lack of a universal social protection system.The implementation of community-based health insurance(CBHI)is a measure the burden of health expenditure on households.As a result,this study aimed to assess the willingness of the inhabitants of urban areas of Cameroon to pay a voluntary(VCHI)or compulsory community-based health insurance(CCHI).Moreover,the study intended to determine the factors that influence the amount paid by subscribers.A cross-sectional study was conducted in the two largest urban areas of Cameroon,namely Douala and Yaounde.A three-stage stratified cluster random sampling design was performed in order to select 3150 participants in each city.The respondents were asked to choose the type of insurance plan they preferred from three schemes(out-of-pocket payment,VCHI and CCHI).Afterwards,a bidding game style based on the contingent valuation approach was performed to evaluate the willingness to pay for the VCHI and CCHI.Our results showed that 87%of respondent were willing to pay any type of CBHI with 46%for CCHI and 41%for VCHI.Furthermore,the household income,working sector,chronic disease,health priority,and the family size were found to be the factors which had the significantly(p<0.001)effect on the willingness to pay CCHI or VCHI.An increase in household income has a positive effect on household’s desire for both CCHI and VCHI.While for VCHI,increase of children number resulted in an increment of the premium,contrary to the occurrence of chronic ailment which led in the decrease of the bid.At last,this study pointed out that the mean amount to pay monthly per households for CCHI was 9.03 USD and for VCHI was 8.17 USD.In conclusion,CCHI is more appealing to Cameroonians,probably because it does not take into account the size and prevalence of disease in the family.However,it implies that for an effective implementation of this type of health insurance,it will require the contribution of exogenous factors,in the form of external government support and the ability to increase the number of community subscriptions.