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Corruption and informal sector households' participation in health insurance in Sierra Leone

Jofre-Bonet, M. ORCID: 0000-0002-2055-2166, Kamara, J. & Mesnard, A. ORCID: 0000-0001-6899-9138 (2023). Corruption and informal sector households' participation in health insurance in Sierra Leone. PLoS One, 18(4), article number e0281724. doi: 10.1371/journal.pone.0281724


Lack of credibility and trust in fund managers has been highlighted as one of the key reasons why people do not join health insurance schemes in low- and middle-income countries, especially in Africa. This work investigates the impact of corruption on households' willingness to participate and pay for health insurance in Sierra Leone. A discrete choice experiment (DCE) method was used to elicit households' willingness to participate in a health insurance scheme with different attributes. The data were collected from 1458 representative households working in the informal sector of the Northern and Western regions. We explore the relationship between household characteristics and experienced (respectively, perceived) corruption with binary and ordered logit models. We use a Mixed Logit model to estimate the association between corruption and participation in a Health Insurance Scheme (HIS) and households' willingness to pay for a HIS. We find that corruption decreases participation in a public HIS and the willingness to pay for it. Our results highlight the perverse spillover effects of corruption. Not only does corruption hinder the effectiveness of healthcare systems and, thus, worsen health outcomes. It also undermines the willingness to pay for them, jeopardizing the sustainability of healthcare systems in the countries that need them most.

Publication Type: Article
Additional Information: Copyright: © 2023 Jofre-Bonet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Publisher Keywords: Humans; Sierra Leone; Informal Sector; Insurance, Health; Family Characteristics; Delivery of Health Care
Subjects: H Social Sciences > HG Finance
Departments: School of Policy & Global Affairs > Economics
SWORD Depositor:
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