Willingness-to-pay for health insurance: A comparative study between formal and informal health-workers

Abstract

_Introduction_ People in low- to middle-income countries, such as Bangladesh, have less access to healthcare than those in wealthier nations. In Bangladesh, households spend an average of Tk 103.46 billion (US $1.49 billion) on out-of-pocket medical costs each year, which accounts for 64.3% of total health expenditures. The informal sector, which employs 85.1% of the total workforce, has limited or no health insurance (HI). Less than 1% of Bangladesh’s population has access to social health protection, which is mostly limited to those who work in the formal sector (14.9% of all jobs). This comparative study will use the contingent valuation method to determine the willingness-to-pay (WTP) for health insurance and associated factors between formal and informal health workers. _Methods and analysis_ This is the study protocol for a comparative study of the willingness-to-pay (WTP) for health insurance and associated factors between formal and informal health workers using the contingent valuation method (CVM), which will be conducted over a 12-month period, from September 2022 to September 2023. A total of 250 health workers will be selected by a convenience sampling technique from various formal and informal work stations in Dhaka City. Of the 250 participants, 125 will be from the formal sector and 125 will be from the informal sector. To collect data, a semi-structured questionnaire will be used via face-to-face interviews. Data will be processed and analyzed using R (version 4.3.0), RStudio (2023.03.1 Build 446). WTP for social health insurance will be estimated using the DCchoice package. _Ethics and dissemination_ Ethical clearance was obtained from the Institutional Review Board (IRB) of the National Institute of Preventive and Social Medicine (NIPSOM) on December 29, 2022. The memo number is NIPSOM/IRB/2022/14 (1). Informed consent will be taken from each participant before data collection. Privacy and confidentiality of data will be maintained strictly. Participants will have full freedom to refuse to participate at any point in the study. The results of the study will be published in scientific, peer-reviewed journals. _Strengths and limitations of this study_ 1. The contingent valuation method is a well-established method of eliciting WTP for health insurance. 2. The current study will be among the first of its nature as it will focus on formal and informal healthcare workers. 3. Starting point bias may affect the result as this type of bias comes with the Double bounded dichotomous choice (DBDC) method used in this study.