Sociodemographic characteristics:
Among the total 280 respondents 157(56.1%) were males. The respondent’s age ranged from 19 to 58 with mean age of 33.76. The average family size is 3.4 with a median value of 3. The average monthly salary was 9146.20 ETB ranging from 2,400.00 to 13,950.00 ETB with a median value of 9056.00 ETB. Half of 140(50.0%) respondents were bachelor degree holder, whereas 90(32.1%) were master’s degree and 50(17.9%) diploma holders. More than half (196) 70.0% of the respondents have worked for six years or above as a public schools which ranged from 1 to 37 years with mean years of 11.96 (table 1) .
Table 1
Demographic and socioeconomic characteristics of the study participants in Akaki Kality Sub City, Addis Ababa (n= 280).
Value
|
Frequency
|
Percentage
|
Gender
|
|
Male
|
157
|
56.1
|
Female
|
123
|
43.9
|
Age Category (Years)[24]
|
|
≤ 30
|
77
|
27.5
|
31 – 40
|
135
|
48.2
|
> 40
|
68
|
24.3
|
Household Size Category (Number)[24]
|
|
< 3
|
49
|
17.5
|
4 – 6
|
174
|
62.1
|
> 6
|
57
|
204
|
Duration of Service Category (Years)[26]
|
|
< 6
|
84
|
30.0
|
6 – 10
|
140
|
50.0
|
> 10
|
56
|
20.0
|
Educational status
|
|
Diploma
|
50
|
17.9
|
Bachelor degree
|
140
|
50.0
|
Master’s degree
|
90
|
32.1
|
Monthly salary (ETB)[26]
|
|
< 6488.00
|
33
|
11.8
|
6488.00 – 10024.00
|
72
|
25.7
|
> 10024.00
|
175
|
62.5
|
Health and Medical Care Characteristics of Respondents: two hundred thirty one (82.5%), 39(13.9%) and 10(3.6%) were used a direct out-of-pocket payments, traditional insurance (Ekub, Idir, or group based contribution) and freely from external aid as the source of their medical care payments respectively. About 207 (73.9%) of the teachers perceived their health status (self-rated health status) was bad and they did seek medical attention and health service with in the last 12 months prior to the survey either for emergencies or/and chronic medical care. Out of the 207 medical seekers, in 183 (88.4%) getting money to pay for medical expense was difficult for the households who encountered illness in the family. Two third of the respondents that encountered a difficult of pay for medical bills; 142 (68.6%) had no money from pocket, and the rest one third 65 (31.4%) either hadn’t third party to cover healthcare related payment or had unable to loan/borrow from their relative and neighbors on time of seeking care. (table 2).
Table 2
Health related characteristics of study participants in Akaki Kality Sub City, Addis Ababa (n= 280)
Value
|
Frequency
|
Percentage
|
Methods of Health expenditures (Multiple)
|
|
Direct Out-of-Pocket Expenditure
|
231
|
82.5
|
Traditional insurance (Ekub, Idir, group based contribution)
|
39
|
13.9
|
External aid/any third party
|
10
|
3.6
|
Government financing/Free service letter
|
11
|
3.9
|
Seek medical attention in the past 12 months
|
|
Yes
|
207
|
73.9
|
No
|
73
|
26.1
|
Faced difficulty in paying health expense (n= 207)
|
|
Yes
|
183
|
88.4
|
No
|
24
|
11.6
|
Spending pattern during difficult time in paying health expense (Multiple, n=207)
|
|
Cut from other essential expenditures as OOP payment
|
142
|
68.6
|
Borrow from relative and/or neighbor
|
38
|
13.6
|
Any third party to cover healthcare related payment
|
34
|
12.2
|
The Magnitude of SHI’s Awareness and Knowledge among Public School Teacher: The majority 199 (71.1%) of the respondents have heard about SHI from different source. Majority 185(92.9 %) were heard from radio and television, 122 (61.3%) from peers and friends, 97(48.7%) from health professionals and 27(13.6%) from newspaper as their source of information about the SHI. Among 199 (71.1%) of the respondents have heard about SHI; 195(98.0%) knows about SHI’s membership either as voluntary/mandatory, 186 (93.5%) knows the health service package of SHI, 137(68.9%) know the objective of the scheme, 122(61.3 %) knows the possible financial source of SHI, 107(53.8%) heard the proposed amount of salary rate, 81(40.7) timing of payment from payroll based. Among 137(68.9%) those knows the objective of the scheme; 137(100%) believes that the scheme reduce healthcare related financial barriers at the point of service delivery through risk sharing and 136 (99.3%) them believes that SHI should provide quality and sustainable UHC coverage to the beneficiary if the scheme will established. The knowledge of the health service package content of SHI for the beneficiary to cover the healthcare service cost was high as 186(93.5%) among the respondents that heard about the scheme; where 139(74.4%), 117(62.9%), 112(60.2%), 105(56.4%), 85(45.7%), 58(31.2%) and 25(13.4%) believes as the SHI scheme cover the healthcare cost for outpatient care service, inpatient care, diagnosis service, delivery service, surgical care service, generic drugs cost and dialysis of acute renal failure service associated cost respectively. From 195(98.0%) teachers with the knowledge of SHI’s membership; 161(82.6%), 154(79.0%), and 94(48.2%) think as any government employee, any private employee and any pensioners shall be members of the SHI scheme respectively. Among 122(61.3 %) teachers those with knowledge of the proposed sources of finance for SHI; 97(79.5%), 87(71.3%), 33(27.0%) and 66(54.1%) believe that the members’ contributions, the employers’ contributions, the investment income and other related sources should be the sources of finance for SHI scheme respectively. (Table 3)
Table 3
Respondents’ Awareness and Knowledge on SHI, Akaki Kality Sub City, Addis Ababa (n= 280)
Variable Description
|
Value
|
Frequency
|
Percentage
|
Heard about SHI (N = 280)
|
Yes
|
199
|
71.1
|
No
|
81
|
28.9
|
Source of information about SHI (Multiple, n = 199)
|
Radio and television
|
185
|
92.9
|
Friends/Peers
|
122
|
61.3
|
Health professionals
|
97
|
48.7
|
News Paper/guidelines
|
27
|
13.6
|
Knowledge of SHI membership (n = 199)
|
Yes
|
195
|
98.0
|
No
|
4
|
2.0
|
About the membership of SHI (Multiple, n = 195)
|
Any government employee
|
161
|
82.6
|
Any private institution employee
|
154
|
79.0
|
Any pensioners
|
94
|
48.2
|
Knowledge of health service package of the SHI (n = 199)
|
Yes
|
186
|
93.5
|
No
|
13
|
6.5
|
The health service package of the SHI scheme for the beneficiaries (Multiple, n = 186)
|
Outpatient care service
|
139
|
74.4
|
Inpatient care service
|
117
|
62.9
|
Diagnostic service
|
112
|
60.2
|
Delivery service
|
105
|
56.4
|
Surgical care service
|
85
|
45.7
|
Generic drugs cost
|
58
|
31.2
|
Dialysis of acute renal failure
|
25
|
13.4
|
Knowledge of SHI’s objective (n = 199)
|
Yes
|
137
|
69.9
|
No
|
62
|
30.1
|
The benefit of SHI for the beneficiaries (Multiple, n = 137)
|
The scheme reduce healthcare related financial barriers at the point of service delivery through risk sharing
|
137
|
100
|
Provision of quality and sustainable universal health care coverage to the beneficiary
|
136
|
99.3
|
Knowledge of the proposed sources of finance for SHI (n = 199)
|
Yes
|
122
|
61.3
|
No
|
77
|
38.7
|
Possible sources of finance for SHI scheme (n = 122)
|
Members’ contributions
|
97
|
79.5
|
Employers’ contributions
|
87
|
71.3
|
Investment incomes
|
33
|
27.0
|
Other related sources
|
66
|
54.1
|
Prevalence of Willingness to Pay for SHI among Public School Teachers: Among the total of 280(100%) respondents, 257(91.8%) were willing to join SHI scheme. About 208(74.3%) of them had willingness to pay for SHI, while 49(17.5%) them interested to join, but had no WTP for SHI and 23(8.2%) were not interested to be the part of the SHI scheme at all.
Factors that were identified for those decided to willing to pay for the scheme; 208(100%) of the need secured health insurance for their family, 152(73.1%) for healthcare protection of the scheme and minimizing the out of pocket payment, 93(44.7%) for helping the society at risk, and 8(3.8%) to get admiration from friends and family. About 72(25.7%) the respondents’ had not willing to pay for the SHI scheme and not being enrolled were; 64(88.9%) for their experiences of poor quality of public health facility service, 65(90.3%) were preference of out of pocket (OOP) payment for health service, 48(66.7%) considering SHI scheme does not cover all the health care costs, 43(59.7%) had no trust on a health insurance agency, 41(56.9%) claims the proposed amount was too much, 46(63.9%) need for some preconditions from government like back payments, and 35 (48.6%) for lack of money to pay. (table 4)
Table 4
Willingness to Pay for Social Health Insurance among Public School Teachers, Akaki Kality Sub City, Addis Ababa, May 2022
Description of variables
|
Value
|
Frequency
|
Percentage
|
The importance of SHI for teachers (N = 280)
|
Yes
|
270
|
96.4
|
No
|
10
|
3.6
|
Willingness to join SHI scheme (N = 280)
|
Yes
|
257
|
91.8
|
No
|
23
|
8.2
|
Willingness to pay for SHI scheme (n = 280)
|
Yes
|
208
|
74.3
|
No
|
72
|
25.7
|
Main reason for Willingness to Pay for SHI (multiple, n = 208)
|
Health insurance for their family
|
208
|
100
|
Thinking that the SHI would provide healthcare protection
|
152
|
73.1
|
For helping the society at risk
|
93
|
44.7
|
To get admiration from friends and family
|
8
|
3.8
|
WTJ, but don’t want to Pay for SHI scheme (N = 72)
|
Yes
|
49
|
17.5
|
No
|
23
|
8.2
|
Reason for not Willingness to Pay for SHI (multiple, n = 72)
|
Experiences of poor quality of public health facility service
|
64
|
88.9
|
Preference of out of pocket payment for health service
|
65
|
90.3
|
Considering SHI scheme doesn’t cover all the health care costs
|
48
|
66.7
|
Had no trust on a health insurance agency
|
43
|
59.7
|
The proposed amount was too much
|
41
|
56.9
|
Need for some preconditions from government like back payments
|
46
|
63.9
|
Lack of money to pay
|
35
|
48.6
|
Factors Associated with Willingness to Pay for SHI among Public School Teachers: In the unadjusted regression analysis, and after controlling for other confounding factors; age, gender, monthly salary, work experience, family size, knowledge of membership for SHI, knowledge about the finance source for SHI, the proposed amount of monthly salary deduction rate and the time of payment were not significantly associated with the current willingness to pay for the SHI scheme. Teachers have been working in secondary/preparatory schools were 3.02(AOR = 3.02; 95% CI: 1.31, 6.98) times more likely to be willing to pay for SHI as compared to those teachers working in primary schools. Higher educational status were 5.48(AOR = 5.48; 95% CI: 1.80, 16.73) times more likely to be willing to pay for SHI as compared to those teachers who were first and diploma holders. Teachers that ever had a history of difficulty of covering their medical bills were 2.39(AOR = 2.39; 95 % CI: 1.35, 4.24) times more likely to be willing to pay compared with those who didn’t have. Participants who ever heard about SHI were 5.59(AOR = 5.59; 95 % CI: 2.98, 10.48) times more likely to be enrolled to SHI than those who never heard about SHI. Preference of respondents for objective of SHI for the beneficiary as well as prior information about the components and contents that included and excluded in the SHI benefit packages that the schemes cover were 5.98 (AOR = 5.98; 95 % CI: 3.31, 10.81) and 5.56(AOR=5.56; 95 % CI: 3.07, 10.04) times more likely to pay for SHI than those who had no concern about the objective and the benefit health package of SHI respectively. Teachers that lost trust on government’s health insurance agency to offer the intended benefit packages were 0.011 (AOR = 0.011; 95 % CI: 0.003, 0.037) less likely to pay for SHI compared to those had trust the agency(table 5).
Table 5
Factors associated with the Willingness to Pay for Social Health Insurance among Public School Teachers, Akaki Kality Sub City, Addis Ababa, May 2022
Variables
|
WTJP for SHI
|
COR (95% C.I.)
|
AOR (95% C.I.)
|
Yes n (%)
|
No n (%)
|
School type
|
Primary
|
64(29.9%)
|
150(70.1%)
|
1
|
1
|
Secondary/preparatory
|
8(12.1%)
|
58(87.9%)
|
3.09(1.40, 6.85) **
|
3.02(1.31, 6.98) **
|
Educational Status
|
Diploma
|
31(62.0%)
|
19(38.0%)
|
1
|
1
|
Bachelor degree
|
98(70.0%)
|
42(30.0%)
|
1.43(0.73, 2.81)
|
1.32(0.57, 3.06)
|
Master’s degree
|
79(87.8%)
|
11(12.3%)
|
4.43(1.88, 10.31) **
|
5.48(1.80, 16.73) **
|
Experience of any difficulty to pay for healthcare cost
|
No
|
37(38.1%)
|
60(61.9%)
|
1
|
1
|
Yes
|
35(19.1%)
|
148(81.9%)
|
2.61(1.51, 4.52) **
|
2.39((1.35, 4.24) **
|
Ever heard about the SHI
|
No
|
42(51.9%)
|
39(48.1%)
|
1
|
1
|
Yes
|
30(15.1%)
|
169(84.9%)
|
6.07(3.38, 11.88) ***
|
5.59(2.98, 10.48) ***
|
Knowledge about objective of the SHI scheme?
|
No
|
44(50.6%)
|
43(49.4%)
|
1
|
1
|
Yes
|
28(14.5%)
|
165(85.5%)
|
6.03(3.37, 10.78) ***
|
5.98(3.31, 10.81) ***
|
Knowledge about the service package of the SHI
|
No
|
46(48.9)
|
48(51.1%)
|
1
|
1
|
Yes
|
26(14.0%)
|
160(86.0%)
|
5.90((3.305, 10.52) ***
|
5.56(3.07, 10.04) ***
|
Trust on a HIA
|
No
|
32(13.5%)
|
205(86.5%)
|
0.012(0.003, 0.040) ***
|
0.011(0.003, 0.037) ***
|
Yes
|
40(93.0%)
|
3(7.0%)
|
1
|
1
|
The goodness of fit of the model was checked using the Hosmer-Lemshow goodness of fit resulting in X2 = 3.79, p-value = 0.81which indicates the model was good
|