Health insurance coverage and non-coverage Figure 4.3 The household dimension of health insurance coverage 4.3.1 Health insurance coverage by level of informality within the household: the importance of indirect affiliation 60% 4.3.2 Level of health insurance coverage by household income 80% 54.4% 35.8% 34.6% % workers in informal employment covered by health insurance 50% 5% 70% 40% 30% 20% 10% 0% 1.5% 13.5% 1.4% 9.2% 6.4% 19.7% 8.1% 30.2% 20.7% 1% 3% 16% 48% 3% 6% 35% 32% 1% 12% 6% 2% 13% 1% 14% 18% 1% 3% 4% 7% % informal covered 60% 50% 40% 30% 20% 10% Kenya Ethiopia Cote d’Ivoire Zambia Senegal Benin Fully informal HH Mixed HH Fully informal HH Mixed HH Fully informal HH Mixed HH Fully informal HH Mixed HH Fully informal HH Mixed HH Fully informal HH Mixed HH 0% Less than 1/2 MW 1/2 MW – Minimum wage [MW] MW – 2 MW 2 MW – 8 MW More than 8 MW Benin Zambia Senegal Côte d’Ivoire Kenya Ethiopia PHI: Private health insurance PHI: microinsurance SHI(public health insurance) Coverage(SHI+ PHI) . Note: The reference is the selected household member in informal employment, taking into consideration the composition of the household in which they are living(Figure 4.3.1) and household income(Figure 4.3.2). In Figure 4.3.1, the selected worker in informal employment is in a »fully informal household« if all other household members in employment are also in informal employment. They are in a»mixed household« if at least one household member is in formal employment. 4.3 PERCEPTIONS OF AND WILLINGNESS TO JOIN A SOCIAL HEALTH INSURANCE SCHEME This section looks at the majority of workers in informal employment who are not yet members of a social health insurance scheme – ranging from 64 per cent in Ethiopia to 98 per cent in Zambia and Benin – and assesses their interest in joining a health insurance scheme, the preferred modali­ties in terms of frequency of payment of contributions, and the amount they would be ready to pay. Those not interested in joining were asked directly for their main reason. It should be noted that some respondents may not have been aware of the concept of health insurance. 4.3.1 Willingness to join Among workers in informal employment who are not cov­ered, a clear majority expressed an interest in joining a social health insurance scheme. The proportion ranges from 56 to 58 per cent in Benin and Zambia to 71 to 74 per cent in ­Ethiopia, Kenya and Senegal, and 81 per cent in Côte d’Ivoire. There is no significant difference between women and men (Table 4.A6 in Annex), while living in urban or rural areas is relevant in three countries(Kenya, Senegal, Côte d’Ivoire) but plays no role in the others(Benin, Ethiopia, Zambia). By contrast, the capacity to pay contributions obviously influences people’s willingness to join a health insurance scheme, as can be shown if individual or household income is considered(Figures 4.4.2 and 4.4.3). This positive correla­tion affects all six countries, though with some reservations among informal workers at the upper levels of income, especially in Senegal and Ethiopia, where a lack of trust prevails. 13 To a lesser extent, the willingness to contribute also increases in most of the six countries with the level of education(Table 4.A7). The level of education is often asso­ciated with higher income, but possibly also with a higher level of awareness about rights, obligations and services. Finally, employers seem more likely to be interested in join­ing a health insurance scheme than own-account workers and employees(Table 4.A8). Whether it is for personal and family purposes or whether their interest in covering their employees matters cannot be assessed here. 13 In those two countries the CMU and CBHI are associated with cover­age of poor people, and therefore people in higher income quintiles, regardless of employment formality, may not have a positive percep­tion of the schemes. 29