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Willingness to Pay for Community-based Health Insurance and its Correlates among Households in Wukro and Setit-humera Towns, northern Ethiopia: A Cross-sectional Study

Goitom Gigar
Gebremedhin Berhe Gebregergs
Estifanos Gebremeskel
Atakilti Abrha
Berihu Mesfin


The study aimed to assess willingness to pay for community-based health insurance and its correlates among households in Wukro and Setit-humera towns, Tigray, Northern Ethiopia for the year 2016. A community-based survey was conducted in Wukro and Setit-humera towns of the Tigray region from August 30 to October 05, 2016. A total of 823 households were enrolled using a two-stage sampling. A structured, pre-tested, and interviewer-administered questionnaire was used.  Data were entered and analyzed using SPSS version 20. Frequencies, mean, and median were calculated. Bivariate and multiple variable logistic regressions were fitted. Odds Ratio with 95% CI was used to see the associations between selected independent variables and the outcome variable. Willingness to pay for community-based health insurance (CBHI) in the two towns was 93.4% with a 95% CI (91.6-95.0). The median amount of money that households are willingness-to-pay (WTP) was 11.1 USD. The mean amount of money an individual household is willing to pay was significantly higher in Setit-humera than in Wukro town. Participants who knew their monthly income were two times more likely to be willing to pay for CBHI [Adjusted odds ratio (AOR) =2.6, 95% CI; 1.1, 8.1]; and willingness was higher among households who perceived that the cost of care is affordable in health facilities [AOR=2.6, 95% CI; 1.02, 7.1]. The study has shown a high level of willingness to pay for health insurance. Perceived affordability and knowledge of monthly income were significant factors that affect willingness to pay for community-based health insurance. Therefore, it can be operationalized in urban settings provided that the community is aware and sensitized focusing on the benefits of health insurance. Besides, the premium needs to be carefully set to consider the community’s ability to pay.