willingness to pay for healthcare€¦ · * eb –enumeration block, hh - household....

Willingness to pay for Healthcare in Sarawak

More Than RM1?

30/10/2017 1

Dr Azizah Azhar (PKB Sri Aman)Prof. Dr Md Mizanur Rahman (UNIMAS)

Introduction

• How much value is put on health care service by the public?

• Are they willing to pay more than RM 1 for primary health care service in outpatient clinics?

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Introduction (2)

• Assess public support towards health care funding

• Objectives

– To determine the public willingness to pay for primary health care services (payment per visit)

– To identify factors that influencing willingness to pay for primary health care services

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Methodology

Cross sectional study quantitative study

Multistage cluster sampling

Contingent valuation method

Face to face questionnaire assisted interview

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Sarawak

Southern Zone Central Zone Northern Zone

Kuching Division Sibu Division Limbang Division

Kuching Lundu Sibu Selangau Limbang Lawas

8 EB 8 EB 8 EB 8 EB 8 EB 8 EB

211 HH 211 HH 211 HH 211 HH 211 HH 211 HH

* EB –enumeration block, HH - household

Socio-Demographic Characteristics

Variables Frequency Percentage

Age (years)

<25 199 19.5

25-34 314 30.8

35-44 238 23.4

45-54 140 13.8

≥55 127 12.5

Mean (SD) = 36.61(13.30)

years

Minimum =18 years, Maximum= 79 years

Gender

Female 592 58.2

Male 426 41.8

Ethnicity

Iban 490 48.1

Malay 420 41.3

Other Bumiputera 60 5.9

Chinese 48 4.7

6

32%

31%

37%

Participants Distribution

Kuching

Sibu

Limbang

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Socio-Demographic Characteristics (2)

Single/Divorced 32%

Married 68%

Marital Status

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36%

48%

16%

Family Size

2 or less

3 to 5

6 or more

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Mean (SD)= 3.55 (1.99) Minimum= 1 member, Maximum = 13 members

120

201

486

211

0

100

200

300

400

500

600

No Schooling Primary Secondary Tertiary

No Schooling Primary Secondary Tertiary

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Socio-Demographic Characteristics (5)Level of Education

11.8 %

19.7%

47.7%

20.7%

490

414

114

0 100 200 300 400 500 600

≤ 800

801-3000

>3000

Household Income (MYR)

≤ 800

801-3000

>3000

30/10/2017 11Median = MYR 900Minimum= MYR 50, Maximum= MYR 13000


(48.1%)

(40.7%)

(11.2%)

35%

11%22%

20%

12%

Occupation

Not working

Farming

Civil servants

Private job

Others

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Preferred place of

treatment

Frequency Percentage

Government Clinic 833 81.8

Government Emergency

Department

51 5.0

Private Facilities 134 13.2

13

Preferred place of treatment

Distribution of Perception of Health Care Delivery

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52%

48%

Perception of Health Care Delivery

Good

Poor

409

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Willingness To Pay (WTP)

60%

40%

Willingness to pay distribution

Agree

Disagree(409)

79%

18%

3%

Reasons Not Willing to Pay

Unable toafford

It’s government responsibility Others

(609)

Willingness To Pay (WTP)

Variables Frequency

n=609

Percentage

Amount WTP (RM)

5-10 519 51.0

11-20 155 15.2

21-30 93 9.1

31-40 66 6.5

41-50 47 4.6

51-60 17 1.7

Other amounts (RM)

Less than 5 72 7.1

61-100 8 0.8

300 1 0.1

Yea-saying 9 0.9

16

Median= RM 5.40

Factors Affecting WTP Variables Model 1

Not WTP or Yes

βOR

(95% CI)

Residence

Urban (ref) - -

Rural -0.38* 0.69(0.51, 0.91)

Age (years)

<25 (ref) - -

25-34 -0.26 0.77(0.52,1.15)

35-44 -0.57** 0.57(0.37,0.86)

45-54 -0.44 0.65(0.40,1.03)

≥55 -0.21 0.81(0.50, 1.31)

Marital status

Single (ref) - -

Married 0.43** 1.54(1.16,2.04)

17

Factors Affecting WTP Variables Not WTP or WTP

βOR

(95% CI)

Occupation

Not working (ref) - -

Farmer -0.30 0.74(0.89, 2.06)

Civil Servants -1.00*** 0.37(1.60, 4.64)

Private Sector 0.65*** 1.91(1.20-3.06)

Others 0.52* 1.68(1.04, 2.71)

Health Care Provider Preferred

Government (ref) - -

Private -0.49* 0.61(0.42,0.89)

Perception of HC Delivery 0.17* 1.19(1.01, 1.40)

Constant 0.18 0.43

n 1018

Model Chi Square (df) 98.32 (12)***

Goodness of fit > 0.05

Ref Reference category 18*p< 0.05; **p< 0.01;***p< 0.001

Discussion

• Aizuddin et al. (2011) -3/4 who were farmers in Selangor.

• Mean ; RM 4.43 (government)

»RM 5.62 (private)

• Many study focus in willingness to pay for health insurance, limited on payment per visit

• Limitation

– Yea saying, anchor bias, protest no

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• Increasing the amount of payment during registration can be one of the feasible options apart from introducing health care insurance.

• Improving the delivery of health care and the quality of PHC service especially in government setting – may encourage more public to willing to pay

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Recommendation

References

• Aizuddin, A., Hod, R., Rizal, A., Yon, R., & Al Junid, S. (2011). Ability and Willingness to Pay for Health Care and Contribute To National Healthcare Financing Scheme Among Farmers in Selangor. Journal of Community Health, 17(1), 56–63.

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Thank You

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willingness to pay for healthcare€¦ · * eb –enumeration block, hh - household....

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