Presentation (CTI)

OBJECTIVES: This study aims to combine and analyze data from existing research that specifically measures people's willingness to pay for health insurance in developed regions.
METHODS: This systematic review uses a narrative synthesis approach. It involves a comprehensive search of nine databases. The search covers all publications from the databases' inception until June 2025. Studies are included if they are in English or Arabic and focus on adults aged 18 and over from upper-middle-income countries (UMICs) and high-income countries (HICs) in Africa and Eurasia. The primary requirement for inclusion is that the study must measure willingness to pay (WTP) for non-commercial health insurance schemes using contingent valuation (CV) methods. The quality of each study will be evaluated using the Critical Appraisal Skills Program (CASP) tool.
RESULTS: Fifteen studies with 18,329 participants were included. The majority used cross-sectional CV methods, with some mixed-methods and one longitudinal study. Monthly WTP ranged from USD 1 to 347, representing 0.4% to 8% of income with 29% and 98%, respectively, likely to report a willingness to participate and/or pay for health insurance. Higher values were observed in HICs, where contributions often exceeded 3% of income. Mandatory or social health insurance schemes consistently achieved higher WTP compared to voluntary or community-based models, as well as other types. Finally, dichotomous choice and payment cards produced higher estimates than open-ended or bidding formats.
CONCLUSIONS: WTP for health insurance varied significantly based on income level, the type of insurance plan, and the method used to determine the value. This highlights the crucial need to design premium costs that match the local economy's ability to pay. Doing so is essential for making health insurance affordable and fair, which in turn helps create a sustainable system for funding healthcare.