Willingness to Pay for Universal Health Coverage among the General Population in Armenia

BACKGROUND: In Armenia, as in many low and middle-income countries, a large segment of the population is still required to make high out-of-pocket payments to obtain essential services at the secondary or tertiary levels of healthcare. Countries are showing growing interest to provide financial protection to their citizens via a universal health coverage system. We assessed the willingness to pay for universal health coverage (UHC) among the general population of Armenia, and the factors that influence their willingness to pay. METHODS: We administered a national telephone survey (random digit dialing), among the adult population (18-65 years old) of Armenia. Multivariable logistic regression was applied to analyze the data. RESULTS: The total number of survey participants was 787 with a 67% response rate. The mean age of the study participants was 41, and 55% of them were women. The majority of participants (60%) were employed. Around 45% of participants had an average monthly expenditure below AMD 200,000 (about USD 510) and more than one-third (36%) of participants had an average monthly income below AMD 200,000. The majority (72%) of participants were willing to pay 2%−6% of their monthly income to obtain UHC. Multivariable logistic regression analysis showed that one year increase in participants’ age was associated with a small decrease in willingness to pay (OR = 0.97, CI = 0.96; 0.99). Participants with an average monthly expenditure of more than AMD 200,000 (about USD 510) were about 3.4 times more likely to pay 2%−6% of their monthly income than those with an average monthly expenditure of less than AMD 200,000 (OR = 3.44, CI = 1.63; 7.30). CONCLUSIONS: UHC could be a viable solution for improved healthcare access; however, socioeconomic factors influence public readiness to pay for it. To successfully implement a UHC system, governments need to design progressive premium contributions providing more subsidies to lower socioeconomic groups of their populations. KEY MESSAGES: • Socioeconomic factors of a population can impact their willingness to pay for a universal health coverage system. • Governments must tailor premium contribution to UHC systems to the socioeconomic composition of their populations and implement progressive contribution approaches.