Eliciting Preferences for Health Insurance in Iran Using Discrete Choice Experiment Analysis

Document Type : Original Article

Authors

1 Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia

Abstract

Background
The preferences of Iranians concerning the attributes of health insurance benefit packages are not well studied. This study aimed to elicit health insurance preferences among insured people in Iran during 2016.

 
Methods
A mixed methods study using a discrete choice experiment (DCE) approach was conducted to elicit health insurance preferences on a total sample of 600 insured Iranians residing in Tehran. The final design of the DCE included 8 health insurance attributes. Data were analyzed using conditional logistic regression models.

 
Results
The final model of this DCE study included 8 attributes, and the findings indicated statistically significant (P < .001) increase in the odds ratio (OR) of choosing health insurance at all levels of cost coverage except for the rehabilitation and para-clinical benefits, where at 70% cost coverage there was insignificant (P = .485) disutility (OR = 0.95). With the increase in cost coverage level, the probability of choosing health insurance was significantly (P < .001) the highest for the private hospitals’ benefits (OR = 2.82) followed by public hospitals’ benefits (OR = 2.02) and outpatient benefits (OR = 1.75), and the premium revealed statistically significant (P < .001) disutility (OR = 0.96).

 
Conclusion
Our findings revealed that participants would be willing to choose health insurance plans with higher cost coverage of healthcare services and with lower premiums. However, the demographic characteristics, income, and health status of the insured individuals affected their health insurance preferences. The findings can contribute to the design of better health insurance policies, improve the participation of individuals in health insurance, and increase the insured individuals’ utility from the insurance benefits packages.

Keywords

Main Subjects

References

  1. World Health Organization (WHO). The world health report: health systems financing: the path to universal coverage (Arabic). Geneva: WHO; 2010.
  2. Asgary A, Willis K, Taghvaei AA, Rafeian M. Estimating rural households' willingness to pay for health insurance. Eur J Health Econ. 2004;5(3):209-215. doi:10.1007/s10198-004-0233-6
  3. Davari M, Haycox A, Walley T. The Iranian health insurance system; past experiences, present challenges and future strategies. Iran J Public Health. 2012;41(9):1-9.
  4. World Bank, World Bank Data. Rural population (% of total population). https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=IR.5.  
  5. Reports of health insurance organization.  http://ihio.gov.ir. Accessed 2019 February 29, 2019.
  6. Abolhallaje M, Ramezanian M, Abolhasani N, Salarianzadeh H, Hamidi H, Bastani P. Iranian health financing system: challenges and opportunities. World Appl Sci J. 2013;22(5):662-666. doi:10.5829/idosi.wasj.2013.22.05.71247
  7. van den Berg B, Van Dommelen P, Stam P, Laske-Aldershof T, Buchmueller T, Schut FT. Preferences and choices for care and health insurance. Soc Sci Med. 2008;66(12):2448-2459. doi:10.1016/j.socscimed.2008.02.021
  8. Nanna A. Health insurance in developing countries: willingness to pay for health insurance in Thailand using discrete choice experiment methods. Curtin University; 2011.
  9. Kananurak P. An economic analysis of voluntary health insurance after retirement [dissertation]. Thailand: National Institute of Development Administration; 2013.
  10. Brau R, Lippi Bruni M. Eliciting the demand for long-term care coverage: a discrete choice modelling analysis. Health Econ. 2008;17(3):411-433. doi:10.1002/hec.1271
  11. World Health Organization (WHO). Middle Eastern Region: Iran (Islamic Republic of) statistics summary.  https://www.who.int/countries/irn/en/. Accessed 2019 February 27, 2019.
  12. Shadpour K. Primary health care networks in the Islamic Republic of Iran. East Mediterr Health J. 2000;6(4):822-825.
  13. Mehrdad R. Health system in Iran. Journal of International Medical Community. 2009;52(1):69-73.
  14. Nosratnejad S, Rashidian A, Mehrara M, Jafari N, Moeini M, Babamohammadi H. Factors influencing basic and complementary health insurance purchasing decisions in Iran: Analysis of data from a national survey. World Med Health Policy. 2016;8(2):179-196. doi:10.1002/wmh3.187
  15. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health sector evolution plan in Iran; equity and sustainability concerns. Int J Health Policy Manag. 2015;4(10):637-640. doi:10.15171/ijhpm.2015.160
  16. Nosratnejad S, Rashidian A, Mehrara M, Akbari Sari A, Mahdavi G, Moeini M. Willingness to pay for the social health insurance in Iran. Glob J Health Sci. 2014;6(5):154-163. doi:10.5539/gjhs.v6n5p154
  17. Ryan M, Kolstad JR, Rockers PC, Dolea C. How to conduct a discrete choice experiment for health workforce recruitment and retention in remote and rural areas: a user guide with case studies. World Health Organization, CapacityPlus, World Bank; 2012.
  18. Ryan M, Scott DA, Reeves C, et al. Eliciting public preferences for healthcare: a systematic review of techniques. Health Technol Assess. 2001;5(5):1-186.
  19. Louviere JJ, Hensher DA, Swait JD. Stated Choice Methods: Analysis and Application. Cambridge University Press; 2000.
  20. Kazemi Karyani A, Rashidian A, Akbari Sari A, Emamgholipour Sefiddashti S. Developing attributes and levels for a discrete choice experiment on basic health insurance in Iran. Med J Islam Repub Iran. 2018;32:26. doi:10.14196/mjiri.32.26
  21. Orme BK. Getting started with conjoint analysis: strategies for product design and pricing research. Madison: Research Publishers LLC; 2006.
  22. Hauber AB, Gonzalez JM, Groothuis-Oudshoorn CG, et al. Statistical methods for the analysis of discrete choice experiments: a report of the ISPOR Conjoint Analysis Good Research Practices Task Force. Value Healh. 2016;19(4):300-315. doi:10.1016/j.jval.2016.
  23. McFadden D. Conditional logit analysis of qualitative choice behavior. Berkeley: University of California; 1973.
  24. Cushing C, Cushing B. Conditional logit, IIA, and alternatives for estimating models of interstate migration. Annual Meeting of the Southern Regional Science Association; Charleston, SC; 2007.
  25. Rezaei S, Hajizadeh M, Zandian H, Fathi A, Nouri B. Service quality in Iranian hospitals: A systematic review and meta-analysis. Med J Islam Repub Iran. 2018;32:59. doi:10.14196/mjiri.32.59
  26. Kananurak P. Willingness to Pay for Voluntary Health Insurance after Retirement in Thailand. NIDA Development Journal. 2014;54(2):117-157. doi:10.14456/ndj.2014.19
  27. Hershey JC, Kunreuther H, Schwartz JS, Williams SV. Health insurance under competition: would people choose what is expected? Inquiry. 1984;21(4):349-360.
  28. Hajizadeh M, Nghiem HS. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? Int J Health Care Finance Econ. 2011;11(4):267-285. doi:10.1007/s10754-011-9099-1
  29. Etemad K, Yavari P, Mehrabi Y, et al. Inequality in utilization of in-patients health services in Iran. Int J Prev Med. 2015;6:45. doi:10.4103/2008-7802.158169
  30. Yip W, Berman P. Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance. Health Econ. 2001;10(3):207-220. doi:10.1002/hec.589
  31. Liu GG, Zhao Z, Cai R, Yamada T, Yamada T. Equity in health care access to: assessing the urban health insurance reform in China. Soc Sci Med. 2002;55(10):1779-1794.
  32. Obse A, Ryan M, Heidenreich S, Normand C, Hailemariam D. Eliciting preferences for social health insurance in Ethiopia: a discrete choice experiment. Health Policy Plan. 2016;31(10):1423-1432. doi:10.1093/heapol/czw084
  33. Kumar A. Investigating household choice for health and life insurance. Appl Econ Lett. 2019;26(4):267-273. doi:10.1080/13504851.2018.1467543
  34. Haseen F, Adhikari R, Soonthorndhada K. Self-assessed health among Thai elderly. BMC Geriatr. 2010;10(1):1-9. doi:10.1186/1471-2318-10-30
  35. Tamiya N, Noguchi H, Nishi A, et al. Population ageing and wellbeing: lessons from Japan's long-term care insurance policy. Lancet. 2011;378(9797):1183-1192. doi:10.1016/s0140-6736(11)61176-8
  36. Brown JR, Finkelstein A. Why is the market for long-term care insurance so small? J Public Econ. 2007;91(10):1967-1991. doi:10.1016/j.jpubeco.2007.02.010
  37. Hurd MD, McGarry K. Medical insurance and the use of health care services by the elderly. J Health Econ. 1997;16(2):129-154.
  38. Jowett M, Contoyannis P, Vinh ND. The impact of public voluntary health insurance on private health expenditures in Vietnam. Soc Sci Med. 2003;56(2):333-342.
  39. Kermani MS, Ghaderi H, Yousefi A. Demand for medical care in the urban areas of Iran: an empirical investigation. Health Econ. 2008;17(7):849-862. doi:10.1002/hec.1308
  40. Allcock SH, Young EH, Sandhu MS. Sociodemographic patterns of health insurance coverage in Namibia. Int J Equity Health. 2019;18(1):16. doi:10.1186/s12939-019-0915-4
  41. Rezaei S, Woldemichael A, Zandian H, Homaie Rad E, Veisi N, Karami Matin B. Dental health-care service utilisation and its determinants in West Iran: a cross-sectional study. Int Dent J. 2018;68(3):176-182. doi:10.1111/idj.12346
  42. Kerssens JJ, Groenewegen PP. Consumer preferences in social health insurance. Eur J Health Econ. 2005;6(1):8-15. doi:10.1007/s10198-004-0252-3
  43. Ahmadzadeh N, Ebadi Fard Azar F, Baradaran HR, et al. Availability of outpatient rehabilitation facilities in 2015 in Iran: A nationwide study. Med J Islam Repub Iran. 2018;32:123. doi:10.14196/mjiri.32.123
  44. 45 Abiiro GA, Torbica A, Kwalamasa K, De Allegri M. Eliciting community preferences for complementary micro health insurance: a discrete choice experiment in rural Malawi. Soc Sci Med. 2014;120:160-168. doi:10.1016/j.socscimed.2014.09.021
  45. Booske BC, Sainfort F, Hundt AS. Eliciting consumer preferences for health plans. Health Serv Res. 1999;34(4):839-854.
  46. Kerssens JJ, Groenewegen PP. Consumer choice of social health insurance in managed competition. Health Expect. 2003;6(4):312-322. doi:10.1046/j.1369-7625.2003.00229.x
  47. Glazer J, McGuire TG. Optimal risk adjustment in markets with adverse selection: an application to managed care. Am Econ Rev. 2000;90(4):1055-1071.
  48. Rothschild M, Stiglitz J. Equilibrium in competitive insurance markets: An essay on the economics of imperfect information. Q J Econ. 1976;90(4):629-649. doi:10.2307/1885326
  49. Buchmueller TC, Monheit AC. Employer-sponsored health insurance and the promise of health insurance reform. Inquiry. 2009;46(2):187-202. doi:10.5034/inquiryjrnl_46.02.187
  50. Nyman JA. The value of health insurance. Chapters; 2006.
  51. Hajizadeh M, Connelly L, Butler JRG, Khosravi A. Unmet need and met unneed in health care utilisation in Iran. Int J Soc Econ. 2012;39(6):400-422.
  52. World Health Organization (WHO). Designing health financing systems to reduce catastrophic health expenditure. Geneva: WHO; 2005.
International Journal of Health Policy and Management
Volume 8, Issue 8
August 2019
Pages 488-497

Files

History

  • Receive Date: 03 July 2018
  • Revise Date: 21 April 2019
  • Accept Date: 08 May 2019
  • First Publish Date: 01 August 2019

Share

How to cite

Statistics