Hindawi

Advances in Public Health

Volume 2020, Article ID 6458425, 9 pages
https://doi.org/10.1155/2020/6458425

Research Article
Acceptance for Social Health Insurance among Health
Professionals in Government Hospitals, Mekelle City,
North Ethiopia

Alemtsehay Tewele,1 Mezgebu Yitayal ,2 and Adane Kebede2

1
Department of Health System, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
2
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences,
University of Gondar, Gondar, Ethiopia

Correspondence should be addressed to Mezgebu Yitayal; mezgebuy@gmail.com

Received 16 October 2019; Revised 10 April 2020; Accepted 23 April 2020; Published 6 May 2020

Academic Editor: Jagdish Khubchandani

Copyright © 2020 Alemtsehay Tewele et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background. Ethiopia is one of the countries with high out-of-pocket payments leading to catastrophic health expenditure. The
government of Ethiopia introduced social health insurance (SHI) scheme with the overall objective of achieving universal health
care access. Studying health professionals’ acceptance to pay for social health insurance is crucial for the successful imple-
mentation of the scheme. Therefore, this study aimed to assess the acceptance of social health insurance and its associated factors
among health professionals in government hospitals, Mekelle city, North Ethiopia. Methods. An institution-based cross-sectional
study design was used. The study participants were selected using systematic random sampling. Data were collected using a
structured interviewer-administered questionnaire and analyzed using SPSS version 20. Bivariable and multivariable logistic
regression models at a 5% level of significance, and odds ratios with 95% CI level were used to determine the association between
the health professionals’ acceptance of health insurance and explanatory variables. Results. The study revealed that 62.5% of the
respondents were willing to participate in the SHI scheme in which 74.9% were willing to pay 3% or more of their monthly salary.
Health professionals’ acceptance for SHI significantly associated with monthly salary (AOR = 9.49; 95% CI: 2.51, 35.86), awareness
about SHI (AOR = 3.89; 95% CI: 1.05, 14.28), history of difficulty in covering medical bills (AOR = 6.2; 95% CI: 2.42, 15.87),
attitudes towards social health insurance (AOR = 7.57; 95% CI: 3.14, 18.21), and perceived quality of health care services if SHI
implemented (AOR = 2.89; 95% CI: 1.18, 7.07). Conclusion. The study indicated that there were still a high proportion of health
professionals who were not willing to pay for SHI. Therefore, strengthening awareness creation, creating awareness about SHI,
promoting the scheme using the different channels of communication to bring about favorable attitude, and providing health care
services with required standard quality could help to increase the acceptance of SHI by health professionals.

1. Background people affected reside in low-income countries [4]. A survey

of 89 countries indicate that 3%, 1.8%, and 0.6% of
Social health insurance (SHI) is a health care funding households face catastrophic health expenditure in low,
mechanism that plays an important role in cross-subsidi- middle-, and high-income countries, respectively [5]. Be-
zation and reducing the influence of high costs of health care sides, a cross-sectional survey in Mongolia, Burkina Faso,
[1]. It is characterized by compulsory universal coverage and and Uganda show that 5.5%, 15%, and 2.6% of households
financed by employers and individual contributions [1, 2]. suffered from catastrophic health expenditures, respectively
Globally, 150 million people face financial catastrophe, and [6–8]. In Ethiopia, out-of-pocket spending is very high
about 100 million people are pushed into poverty annually accounting for 37% of the total expenditure in the health
due to the need to pay for health services [3], and 90% of the sector [9].
2 Advances in Public Health

A systematic review of WTP for health insurance from have served at least 3 months were included in the study. All
ten countries in low- and middle-income countries showed health professionals who were expatriates were excluded
that the mean WTP of individuals and households is 1.18% from the study.
and 1.82% of GDP per capita and 1.39% and 2.16% of ad- The sample size was determined using single population
justed net national income per capita, respectively [10]. proportion formula by taking 53% of the health profes-
Studies indicate that the average WTP for SHI per person sionals are willing to pay for SHI [20], 5% margin of error,
per month in Iran was 5.5 $US [11], and households in 95% CI, and 10% nonresponse rate.
Vietnam are willing to pay 4% of their income for health N � (Zα/2)2 × p × [1-p]/w2 � (1.96)2 × 0.53 × (1–0.53)/
insurance [12]. In Malaysia, 72.5% of the academic staff are 0.0025 � 382.78
willing to pay an average of RM 79.32 per month per The final sample size was 382.78 + 38.28 (response
household [13], and 71.2% of patients attending specialist rate) � 421.06 ≈ 421.
clinics supported the proposed NHI and 61.4% are willing to Three government hospitals in the study area were in-
pay up to $ 192 per year [14]. cluded in the study, and a list of the health professionals was
In Africa, studies indicate that 30% of households in obtained from the three hospitals. The sample was allocated
South Africa [15], 90% of households in Ghana [16], 87% of to each hospital proportional to the number of health
the uninsured respondents in Namibia [17], and 52.5% of professionals in each hospital, and a systematic random
civil servants (18) and 89% of households in Nigeria [18] are sampling technique with a sampling interval of 3 was used to
willing to pay for health insurance schemes. Besides, 63.6% select the study participants.
of households in Ghana and 43.8% of households in Nigeria
are willing to pay a premium of $3.03 a month [16] and 5%
mandatory premium [18], respectively. Households in 2.3. Study Variables
Ghana are also willing to pay 1.9%–2.5% of their income for 2.3.1. Response Variable. The response variable of the study
health insurance [16]. In Ethiopia, studies indicate that was the acceptance of SHI among health professionals.
69.8% of civil servants in Debre Markos [19] and 71.3% of Acceptance of SHI was measured by asking the respondents
teachers in Wolaita Sodo [20] are willing to pay the proposed “Are you willing to pay for SHI? The alternative options were
premium (3% of their salary) for SHI. “Yes” if respondents were willing to pay 3% and above of
Evidence shows that sociodemographic and economic monthly salary or “No” if respondents were not willing to
factors such as the age of household head [10, 16, 21], sex pay at least 3% of their monthly salary. The 3% premium was
[17, 21–23], level of education [11, 24], family size set by the government of Ethiopia to implement the SHI
[10, 11, 25], and economic status of the households [31].
[16, 26, 27]; health and health-related factors such as health
status [20, 25, 28, 29]; and awareness, knowledge, and at-
titude towards health insurance schemes [14, 20, 30] de- 2.3.2. Explanatory Variables. The sociodemographic and
termine the acceptance of SHI. However, there is limited economic factors (age, sex, education, marital status, family
evidence in the study area. Therefore, this study aimed to size, children <5, adults >64 years, monthly salary, and
assess the acceptance of SHI and its associated factors among wealth status); health and health-related factors (perceived
health professionals in government hospitals, Mekelle city, health status, presence of chronic disease, history of illness
Ethiopia. within 6 months of the survey, history of difficulty covering
the medical bill); and health insurance-related factors
(awareness or ever heard about SHI, knowledge, attitude
2. Methods toward social health insurance and health insurance expe-
2.1. Study Design and Setting. An institution-based cross- riences) were the explanatory variables.
sectional study design was used to assess acceptance for
social health insurance and its associated factors among 2.3.3. Knowledge of SHI. Knowledge of study participants
health professionals in Mekelle city. The study was con- about SHI was assessed by asking them a set of 10 questions
ducted in Mekelle city which is 783 km away from Addis about social health insurance, and the right answer was given
Ababa, the capital city of Ethiopia. According to the 2007 a value of 1 and 0 for those incorrect answers. Respondents
Census, the town has a total population of 273,000. Ad- who had a score greater than or equal to the mean score were
ministratively, it is divided into seven subadministrative considered as good knowledge about SHI unless as poor
units. According to the Mekelle City Health Office report in [14].
2016, the city has one Teaching Referral Hospital and two
General Hospitals staffed with 1,440 health professionals.
2.3.4. Attitude towards SHI. Attitude was defined as what
the health professionals think or feel about SHI and mea-
2.2. Study Population and Sampling Procedures. The source sured using 6 questions: (1) the proclamation of SHI by the
population of this study was all health professionals in the Ethiopian government is good; (2) social health insurance is
government hospitals in Mekelle city. The study population very important; (3) redistribution of health care cost from
of this study was health professionals from randomly se- sick to healthy is good; (4) the arrangement of making
lected government hospitals. All health professionals who monthly deduction from salary for SHI is good; (5) social
Advances in Public Health 3

health insurance should be made compulsory; and (6) social Orthodox Christians, 54.4% were married, and 68.6% had
health insurance is a program that should be initiated and family size ≤ 3. Majority (57.1%) of the study participants
sustained. Each question contains five points Likert scales were nurses followed by physicians (15.2%). The mean age of
(1 � strongly disagree, 2 � disagree, 3 � neutral, 4 � agree, respondents was 32 ± 6.7 years (Table 1).
5 � strongly agree). Those who had a mean score greater than
3 were considered as having a positive/favorable attitude
3.2. Health and Health-Related Characteristics of the
otherwise negative/unfavorable [32].
Respondents. Out of 408 health professionals participated,
87.5% perceived their health status (self-rated health status)
2.3.5. Wealth Status. The wealth status of study participants as good, 10.5% had a chronic medical illness, 18.4% had a
was assessed based on housing condition and durable assets history of at least one episode of illness within six months of
and divided into three equal parts: low-, middle-, and high- the survey, and 99% got treated of them 78% was treated in
wealth status. government health institutions. Regarding medical bills of
treatment, 75.6% of those who had a history of illness within
six months of the survey were treated freely and 20.1% of
2.4. Data Collection Procedures. A structured interviewer- study participants ever had a history of covering medical
administered questionnaire was developed by reviewing the bills (Figure 1).
literature on acceptance of health insurance
[10, 11, 13, 20, 27–30, 33, 34]. It had closed-ended questions
consisting of sociodemographic characteristics, economic 3.3. Awareness, Knowledge, and Attitudes about Social Health
status, health status, knowledge and attitude, and acceptance Insurance. The study revealed that 84.8% of the respondents
of SHI. For data collection, six students supervised by two ever heard about SHI, and the source of information was
senior nurses were assigned with the principal investigator’s media (39.8%), conferences/meetings (29.1%), colleagues
critical follow up. The data collectors and supervisors were (16.1%), and friends and patients (14%). Only 6.6% of the
approached by the principal investigator and took the data respondents had any form of health insurance previously.
collection training if they agreed to participate in the data The mean score of respondents on knowledge about SHI was
collection process. The data collectors and supervisors were 4.5 ± 2.76, and 59.3% of the respondents had good knowl-
trained for two days on data collection procedures. edge about SHI, 64% of the respondents had a positive
A pretest was conducted on 21 (5% of the sample) health attitude towards SHI, and 50% of the respondents had a
professionals in Wukro hospital, and necessary modification good perception about the quality of health care services if
was done after the pretest. Then, in the final data collection, SHI implemented.
the study participants assisted by the data collectors filled in
the questionnaire. The collected data were checked by the 3.4. Acceptance of Social Health Insurance. The study indi-
data collectors’ supervisors as well as the principal cated that 62.5% of the respondents were willing to par-
investigator. ticipate in the scheme of which 74.9% were willing to pay 3%
or more of their monthly salary. The median (IQR) of
maximum willingness to pay was 3% [1] of monthly salary
2.5. Data Processing and Analysis. Data were entered into
(Table 2). The main reasons for not accepting or not willing
Epi Info version 3.5.1 and exported to Statistical Package for
to participate in the SHI scheme were the respondents’
Social Sciences (SPSS) version 20 for analysis. Data were
perceptions that the government is responsible to finance
cleaned and coded before entry. Descriptive statistics like
SHI and health care services should be free for health
percentage, frequency, mean, median, standard deviation,
professionals because they are at risk for infection (Figure 2).
and IQR were used to show a clear picture of the charac-
teristics of the respondents. For describing wealth status,
principal component analysis (PCA) was used and divided 3.5. Factors Associated with Acceptance of Social Health
into three equal parts (three tiles) as low-, middle-, and high- Insurance. The study revealed that monthly salary, history
wealth status. Initially, bivariable logistic regression at a p of difficulty of covering medical bills, awareness (ever heard)
value of less than 0.25 was used to identify factors inde- about SHI, attitudes towards SHI, and perceived quality
pendently associated with the outcome variable. Then to health care services if SHI implemented were the factors
control the effect of confounding, multivariable logistic statistically associated with acceptance (willing to pay) SHI
regression analysis was done. Statistical significance was among health professionals.
determined using 5% of the level of significance and odds The health professionals who earn ≥10024 ETB monthly
ratio with 95% CI. salary were 9.49 (AOR � 9.49; 95% CI: 2.51, 35.86) times
more likely to be willing to pay for SHI than those who earn
3. Results <6488 ETB. Respondents that ever had a history of difficulty
of covering medical bills were 6.2 (AOR � 6.2; 95% CI: 2.42,
3.1. Demographic and Socioeconomic Characteristics of the 15.87) times more likely to be willing to pay compared with
Respondents. A total of 408 health professionals participated those who did not have. Study participants whoever heard
in the study with a response rate of 97%. The study revealed about SHI were 3.89 (AOR � 3.89; 95% CI: 1.05, 14.28) times
that 50.2% were males, 92% were Tigrie, 85.7% were more likely to be willing to pay for SHI than those never
4 Advances in Public Health

Table 1: Sociodemographic and economic characteristics of health professionals in government hospitals, Mekelle city, North Ethiopia,
2017 (N � 408).
Variables Category Frequency (n � 408) Percentage (%)
Male 205 50.2
Sex
Female 203 49.8
20–30 220 53.9
Age
31–40 146 35.8
≥41 42 10.3
Mean age ± SD
32 ± 6.7
Tigrie 372 91.1
Ethnicity Amhara 17 4.2
Others 19 4.7
Orthodox 353 85.7
Religion Muslim 33 8
Others 22 5.3
Single 168 41.2
Marital status Married 222 54.4
Others 18 4.4
1–3 280 68.6
Family size
≥4 128 31.4
Yes 142 65.2
Children <5
No 266 34.8
Yes 19 4.7
Adults >64
No 389 95.3
Physician 62 15.2
Pharmacist 37 9.1
Nurse 233 57.1
Professions Midwifery 22 5.4
Medical laboratory 29 7.1
Physiotherapy 7 1.7
Others 18 4.4
Diploma 44 10.8
Degree 328 80.4
Level of education
Masters 18 4.4
Specialist 18 4.4
1–5 246 60.3
Work experiences in years 6–10 101 24.7
≥11 61 15
Median (IQR) 5 (4)
<6488 ETB 229 56.1
Monthly salary 6488-10024 ETB 131 32.1
≥10024 ETB 48 11.8
Median (IQR) ETB 6488 (3119)
Low 135 33.1
Wealth status Middle 150 36.8
High 123 30.1

80 75.6
70
60
50
40
30 23
20
10
1.4
0
Free Out of pocket Borrowed
Figure 1: Medical bills of treatment among health professionals in government hospitals, Mekelle City, North Ethiopia, 2017.
Advances in Public Health 5

Table 2: Health professionals’ acceptance for social health insurance in government hospitals, Mekelle City, North Ethiopia, 2017.
Variables Category Frequency Percentage (%)
Yes 255 62.5
Willing to participate in SHI (n � 408)
No 153 37.5
WTP <3% of monthly salary (n � 408) 217 53.2
WTP <3% of monthly salary (n � 255) 64 25.1
WTP >3% of monthly salary (n � 408) 191 46.8
WTP >3% of monthly salary (n � 255) 191 74.9
Median of maximum willing to pay with IQR (%) 3 (1)%

difference in the insurance experiences and premium col-

6.50% 8.1% lection approach. For Example, in Ghana, the formal sector
shall contribute 2.5% of their 17.5% Social Security and
National Insurance Trust (SSNIT) contribution. The con-
9% tribution levels have an inbuilt cross-subsidization mecha-
nism, whereby the rich pay more than the less privileged,
adults pay on behalf of children, the healthy cover for the
sick, and urban dwellers pay more than the rural dwellers
[36], whereas in Ethiopia, the formal sector shall contribute
9.80% 3% per month from the net salary and its similar for all
35%
employee [31].
In this study, 46.8% were willing to pay greater than or
equal to 3% of monthly salary which is lower than the finding
8.60% of a study conducted in Debre Markos, where 68.9% are
willing to pay 3% of monthly salary for SHI scheme. This
disparity could be due to the difference in the burden of
medical bills when seeking health care services [34].
The Median (IQR) maximum premium among those
who were willing to participate was 3% (1) of monthly salary
23% which is in line with the premium proposed by the Ethiopian
government [31] and a study conducted in Addis Ababa city
Feeling being healthy Health care services should [30]. However, it is lower that of than a study conducted in
Prefer out of pocket be free for health proffessionals Vietnam where respondents are willing to pay 4% of their
Feeling unable to pay Government resposibility to
income for SHI [12], and it is higher than the finding from
because of low income finance for SHI
Others
Ghana [16]. This could be due to the socioeconomic dif-
Perception of quality health
care services will be low
ferences among countries.
The results of this study showed that respondents with
Figure 2: Reasons for not accepting social health insurance among high monthly salaries were more likely to be willing to pay
health professionals in government hospitals, Mekelle City, North for SHI. This could be due to their ability to afford health
Ethiopia, 2017. insurance premiums and contribution for SHI being pro-
gressive is good. This finding is in line with the findings of
heard. Health professionals with positive attitudes were 7.57 studies done in Addis Ababa [29], Cameron [37], and
(AOR � 7.57; 95% CI: 3.14, 18.21) times more likely to be Selangor state, Malaysia [38]. However, it contradicts a study
willing to pay than those with unfavorable attitudes. Re- conducted in Malaysia where those with lower salaries are
garding the perceived quality of health care services, those more willing to pay compared with those with a higher
who perceived as good were 2.89 (AOR � 2.89; 95%: CI: 1.18, salary. This could be due to better income that results in
7.07) times more likely and those who perceived as poor better health status, and this lowers the demand for health
were 81% (AOR � 0.19; 95% CI: 0.06, 0.59) times less likely to insurance [13]. In Malaysia, government-subsidized insur-
be willing to pay compared with those with neutral per- ance schemes purchased based on each person’s ability to
ception (Table 3). pay [39] and people with a high salary might prefer private
health care insurance.
Respondents who had previous financial problems to
4. Discussion cover medical bills were more likely willing to pay for SHI.
This study showed that 62.5% of the respondents were This is consistent with findings in rural China which indicate
willing to participate in the SHI which is lower than studies that individuals who worry about medical expenditure are
done in Nigeria [35], Ghana [16], and Eastern Caribbean more willing to pay for health insurance than those who do
[33] where 83.9%, 90%, and 69.5% are willing to participate not [28]. It is also consistent with studies done in Ghana [16]
in SHI scheme, respectively. This may be due to the and Wolaita Sodo, Ethiopia [20].
6 Advances in Public Health

Table 3: Factors associated with acceptance for social health insurance among health professionals in government hospitals, Mekelle city,
North Ethiopia, 2017.
WTP
Variables COR (95%CI) AOR (95%CI)
Yes No
Sex
Male 95 110 1
Female 96 107 1.039 (0.70, 1.53)
Age 1.121 (1.08, 1.16)∗ 1.029 (0.95, 1.11)
Marital status
Married 134 88 3.44 (2.28, 5.20)∗ 1.54 (0.66, 3.58)
Other than married 57 129 1
Family size
1-3 105 175 1 1
≥4 86 42 3.41 (2.19, 5.30)∗ 1.72 (0.62, 4.78)
Children <5 years
Yes 103 39 5.34 (3.41, 8.36)∗ 2.55 (0.95, 5.34)
No 88 178 1 1
Adults >64
Yes 14 5 3.35 (1.18, 9.49)∗ 1.33 (0.29, 6.05)
No 177 212 1 1
Level of education
Diploma 6 38 1 1
Degree and above 185 179 6.54 (2.70, 15.86)∗ 1.32 (0.39, 4.47)
Monthly salary
0-6488 ETB 70 159 1 1
6488-10024 ETB 79 52 3.45 (2.20, 5.40)∗ 1.16 (0.56, 2.607)
≥10024 ETB 42 6 15.9 (6.48, 39.12)∗ 9.49 (2.51, 35.86)∗∗
Wealth status
Low 64 71 1
Middle 68 82 0.92 (0.57, 1.46)
High 59 64 1.02 (0.62, 1.66)
Perceived health status
Good 165 192 1 1
Fair 16 22 0.84 (0.43, 1.66) 0.39 (0.11, 1.35)
Poor 10 3 3.87 (1.05, 14.33)∗ 1.56 (0.14, 17.44)
Chronic medical illness
Yes 32 11 3.76 (1.84, 7.70)∗ 2.43 (0.67, 8.80)
No 159 206 1 1
History of illness in the previous 6 months
Yes 42 33 1.57 (0.94, 2.60)
No 149 184 1
History of difficulty covering medical bills
Yes 61 21 4.37 (2.54, 7.53)∗ 6.2 (2.42, 15.87)∗∗
No 130 196 1 1
Ever heard about SHI
Yes 185 161 10.72 (4.50, 25.54)∗ 3.89 (1.05, 14.28)∗∗
No 6 56 1 1
Have/had health insurance
Yes 18 5 4.41 (1.60, 12.12)∗ 1.98 (0.44, 8.99)
No 173 212 1 1
Knowledge about SHI
Poor 29 137 1 1
Good 162 80 9.56 (5.90, 15.48)∗ 0.77 (0.32, 1.85)
Attitude toward SHI
Positive/favorable 180 81 27.47 (14.08, 53.58)∗ 7.57 (3.14, 18.21)∗∗
Negative/unfavorable 11 136 1 1
Perceived quality of services if SHI is implemented
Poor 11 103 0.44 (0.19, 0.99)∗ 0.19 (0.06, 0.59)∗∗
Good 163 44 15.25 (8.15, 28.52)∗ 2.89 (1.18, 7.07)∗∗
Neutral 17 70 1 1
∗
Statistically significant results at p value<0.25; ∗∗ statistically significant results at p value<0.05; 1: reference category; COR: crude odds ratio; AOR: adjusted
odds ratio.
Advances in Public Health 7

Health professionals whoever heard (aware) about SHI FGD: Focus group discussion
were more likely to be willing to pay than those who never
GDP: Gross domestic product
heard. This finding is consistent with findings from Ebonyi
IQR: Interquartile range
State, Nigeria [40] and Central Vietnam [12]. This could be
SHI: Social health insurance
health professionals whoever heard about SHI are aware of
WTP: Willingness to pay.
the benefits of having health insurance.
Regarding attitude, respondents with a favorable attitude
were more likely to be willing to pay than those with un- Data Availability
favorable attitudes. This is consistent with the finding of a
The datasets supporting the conclusions of this article are
study conducted in southwestern Nigeria [34]. This study
available upon request to the corresponding author. Due to
revealed that perception about the quality of health care
data protection restrictions and participant confidentiality,
services if SHI implemented was positively associated with
participants’ data are not publicly available.
acceptance of SHI. This is similar to the result of research
done in Debre Markos [19].
The main reason mentioned by respondents for not Ethical Approval
willing to participate was that the respondents thought it as
Ethical approval was obtained from University of Gondar
the government’s responsibility to finance for SHI and
Institutional Review Board and Permission letter was se-
health care services should be free for health professionals.
cured from Tigray Health Bureau and respective health
This is similar to a study conducted in Malaysia in which the
institutions.
main reason is that health care services should be provided
free of charge and subsidized fully by the government [38].
In this study, health-related factors like perceived health Consent
status, chronic medical illness, and history of illness were not
statistically significant. This could be due to less financial Written consent from study participants were obtained after
burden for seeking treatment as most health professionals in explaining the purpose of the study and confidentiality was
the study area have privileged access and may get health assured for the information provided by using the coding
services freely. system; questionnaires did not have any personal identifiers
and respondents were informed data are used for study
purpose only. Confidentiality and anonymity were ensured.
5. Limitations of the study Study participants were informed that participation had no
This study could not show the temporal relationship be- impact on the provision of their health care. All forms and
tween acceptance for SHI and explanatory variables due to data related to the study were stored in a locked room in a
the nature of the study design. Another limitation of this secured area, with controlled access available only to the
study could be social desirability bias in which health investigators. Participation in the study was voluntary and
professionals may tend to give favorable responses as they individuals were free to withdraw or stop the interview at
are the main stakeholders for sensitizing and implementing any time.
health-related policies such as SHI.
Disclosure
6. Conclusion This study is part of a master thesis funded by the University
The study indicated that nearly two-thirds of the study of Gondar. The preliminary findings of this study were
participants were willing to participate in the SHI. However, presented at Institute of Public Health, University of
there was still a high proportion of health professionals who Gondar. The funders had no role in the study design, data
were not willing to pay for SHI. Monthly salary, having a collection and analysis, decision to publish, or preparation of
history of difficulty in covering medical bills, awareness the manuscript.
about and attitude towards SHI, and perceived quality of
services if SHI is implemented are factors significantly as- Conflicts of Interest
sociated with health professionals’ acceptance of SHI.
Therefore, strengthening awareness creation, creating The authors declare that they have no conflicts of interest.
awareness about SHI, promoting the scheme using a dif-
ferent channel of communication to bring about favorable Authors’ Contributions
attitude, and providing health care services with required
standard quality could help to increase the acceptance of SHI AT designed the study, developed data collection tools,
by health professionals. performed the analysis and interpretation of data, and
drafted the paper. MY and AK participated in the de-
List of abbreviations velopment of the study proposal, analysis and interpre-
tation, revised drafts of the paper, and revised the
CHI: Community health insurance manuscript. All authors read and approved the final
ETB: Ethiopian Birr manuscript.
8 Advances in Public Health

Acknowledgments South African Medical Journal � Suid-Afrikaanse Tydskrif Vir

Geneeskunde, vol. 96, no. 96, pp. 814–818, 2006.
We are very thankful to the University of Gondar for the [16] W. K. Asenso-Okyere, I. Osei-Akoto, A. Anum, and
approval of the ethical issue and its technical and financial E. N. Appiah, “Willingness to pay for health insurance in a
support. We would like to thank the study participants, data developing economy. A pilot study of the informal sector of
collectors, and supervisors for their participation in the Ghana using contingent valuation,” Health Policy, vol. 42,
no. 3, pp. 223–237, 1997.
study.
[17] E. Gustafsson-Wright, A. Asfaw, and J. van der Gaag,
“Willingness to pay for health insurance: an analysis of the
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