Public Preferences and Willingness to Pay for Social Health Insurance in Iran: A Discrete Choice Experiment

Mohammad  Ranjbar; Mohammad  Bazyar; Ali Kazemi  Karyani; Blake  Angell; Thomas  Lung; Elham  Tayefi; Daniel  Erku; Yibeltal  Assefa

doi:10.18502/jebhpme.v8i2.17182

Mohammad Ranjbar Health policy & management research center, Department of Health Management and Economics, school of public health, Shahid Sadoughi University of Medical sciences, Yazd, Iran
Mohammad Bazyar Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
Ali Kazemi Karyani Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
Blake Angell Centre for Health Systems Science, the George Institute for Global Health, University of New South Wales Sydney, Australia.
Thomas Lung School of Public Health, University of Sydney, Sydney, New South Wales, Australia
Elham Tayefi Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
Daniel Erku Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
Yibeltal Assefa School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia

DOI: https://doi.org/10.18502/jebhpme.v8i2.17182

Keywords: Social Health Insurance, Discrete Choice Experiment, Preferences, Willingness to Pay

Abstract

Background: Current health insurance programs in Iran suffer from low enrolment and are not sufficient to attain the country to universal health coverage (UHC). The study hypothesized that improving the enrollment rate and moving towards more sustainable UHC can be achieved by improving the benefit package and providing new incentives. The objective of this study is to assess public preferences and willingness to pay (WTP) for social health insurance (SHI) in Iran.

Methods: A discrete choice experiment (DCE) was conducted in 2022, using a self-administered questionnaire on 500 participants to estimate WTP and determine individual’s preferences for the SHI plan. Respondents were presented with an eight choice set, and asked to select their preferred one. In each choice set, scenarios were described by eight attributes with varying levels. The conditional logit regression model was used to analyze the participants preferences. WTP for each attribute was also calculated by STATA₁₃.

Results: Most of the included attributes were significant predictors of health insurance package selection. The maximum coverage of hospitalization costs in the private sector, ancillary services such as glasses, canes etc., as well as coverage for hospitalization costs in the public sector and drug costs, were the most important determining factors for this choice. Coverage of preventive dental care did not significantly affect respondent choices. Estimating WTP showed that individuals are willing to pay more for higher financial protection, particularly against private sector costs; the WTP to increase the coverage of hospitalization costs in the private sector from 50% to 90% is estimated at 362,068 IR, Rials per month.

Conclusion: This study identifies the key factors that the population value with regard to health insurance and the tradeoffs they are willing to make between them. Hospitalization, drugs and ancillary services were the most important determining factors for their choice. The data suggests that additional resources coming into the Iranian health system might best be prioritized to covering hospitalization and drug costs and those associated with ancillary services.