Willingness to pay for social health insurance and associated factors among government employees in Jigjiga, Eastern Ethiopia: Mixed Method Study

Abstract Background: Social Health Insurance is a system of financing and managing health care of employees. A million people suffer a health-related financial catastrophe each year, and the majority have difficulty paying health expenditures, which leads government employees to low health service utilization. However, there is no evidence of the status of health insurance in the study area. Therefore, the study aimed to assess willingness to pay for social health insurance and associated factors among government employees, in Jigjiga town, eastern Ethiopia. Method: A mixed method cross-sectional study was used among 578 randomly selected government employees from March 30 to May 30, 2023, in Jigjiga city. Data was collected using a pre-tested semi-structured questionnaire through self-administration, entered into Epi-data version 3.1, and exported to SPSS version 22.0. Binary logistic regression was conducted to identify factors associated with willingness to pay. An odds ratio with a 95% confidence interval was used to interpret the finding and statistical significance was set at p < 0.05. Nine in-depth interviews were used to collect qualitative data, which were then analyzed thematically. Results: Willingness to pay for social health insurance was 69.90%. Factors such as age >39 years old [AOR=6.30, 95 % CI;2.23,17.86], masters and above educational [AOR=0.41, 95% CI; 0.17,0.98], family size >=5 [AOR=0.11, 95% CI; 0.03,0.39], chronic illness in a family [AOR=0.37, 95 % CI; 0.25,0.55], and belief social health insurance as no benefit [AOR= 0.26, 95 % CI; 0.08,0.85] were significantly associated with social health insurance. From in-depth interviews, social health insurance has high acceptance and is considered an appropriate program for the study area. Conclusion: Nearly seven out of ten government employees are willing to pay for the proposed SHI. Age, educational status, family size, presence of chronic disease, and belief in SHI benefits are associated with willingness. A strong emphasis on implementation and providing necessary information for employees should be given to enhance their knowledge. It would be better to advocate the SHI for policymakers in order to start early implementation of the SHI in the Somali region.