Elsevier

Public Health

Volume 211, October 2022, Pages 144-148
Public Health

Themed Paper– Original Research
Willingness to pay to enhance pandemic preparedness in Mauritius

https://doi.org/10.1016/j.puhe.2022.07.017Get rights and content

Abstract

Objectives

The objective of this study is to assess the determinants of willingness to pay to enhance pandemic preparedness in Mauritius.

Study design

A contingent valuation method is used to estimate willingness to pay to pay for enhancing pandemic preparedness using a sample of working people in Mauritius.

Methods

A two-phase decision process analysis is carried out to model the willingness to pay to enhance pandemic preparedness. The first phase is to analyse the respondents' decision of whether or not to pay for enhancing pandemic preparedness using a Probit model. The second phase is to estimate the determinants of the amount of money respondents are willing to pay using a Tobit model.

Results

Income earners are willing to pay an average of Rs. 1,900 (approximately USD 50) per annum to enhance pandemic preparedness. ‘Perceived Response Efficacy’, ‘Awareness of the Need and Responsibility for Paying’, ‘Subjective Obligation to Pay’ and the ‘Theory of Planned Behaviour’ are found to affect both stages of of the decision-making process. Knowledge on COVID-19 is found to have a positive impact on the decision to pay and health responsibility attitude is found to have a negative impact on the amount people are willing to pay.

Conclusions

On average, the government can potentially expect to mobilise an additional Rs. 1,047,470,000 (USD 27,565,000) from taxpayers to spend on enhancing pandemic preparedness in Mauritius. To increase willingness to pay for enhanced pandemic preparedness, the government can focus on improving knowledge on a pandemic, perceived response efficacy and awareness on need and responsibility of paying.

Introduction

With the harms that came with the emergence of Covid-19 and increasing threats of future pandemics, there are growing concerns about the state of pandemic preparedness. Although enhancing pandemic preparedness requires additional financial resources, governments are under budget stress that prompts decision-makers to seek people's preference to support enhancing pandemic preparedness. The question addressed in this article is whether the tax-paying households would be willing to pay additional money in the form of taxes to enhance pandemic preparedness. This study uses contingent valuation (CV) to assess the value and importance of enhancing pandemic preparedness in Mauritius and its determinants. CV is a stated preference method that has been widely used to assess public preferences through eliciting the willingness to pay (WTP) values. It is a hypothetical approach that uses surveys to place economic values on public goods by obtaining information on preferences and determining what they would be willing to pay for public services when prices are not available.1,2

CV can be used to elicit WTP for different purposes, including informing the budget-allocation decisions of publicly financed healthcare systems, assessing demand, measuring the value of certain aspects or attributes of healthcare services, and determining the prices of goods/services to be traded on the market. It can also be used to inform policymakers of the extent and source of other resources that could be mobilised to finance the healthcare system or health programmes.3, 4, 5 CV can provide significant information for decision-makers to signal and support the prioritisation of enhancing pandemic preparedness.

To the best of the authors' knowledge, no study has explored the WTP for pandemic preparedness, but there are studies that have applied WTP in other areas, such as in preparedness for natural calamities,6, 7, 8, 9 for a pandemic influenza vaccination programme,10 for enhancing local emergency preparedness,11 for disaster preparedness12 and, more recently, for an early warning system for infectious diseases.13

Nine major components are used in this study in guiding WTP for improving pandemic preparedness in Mauritius. Fig. 1 illustrates the conceptual framework. Individuals' attitudes towards their health responsibility can offer important information about their medical decision-making.14 Knowledge about health issues is also a vital component of health literacy and can be considered as a prerequisite for health decision-making processes.15,16 Moreover, the threats of widespread pandemics have become a major public health concern, especially with the emergence of the COVID-19 pandemic.17, 18, 19

Furthermore, altruistic behaviour is an important element of WTP in the current context. Altruistic motivation can cause perceived obligations to contribute to the enhancement of pandemic preparedness in a country. It follows that a financial contribution to a specific enhancement of the pandemic preparedness may give personal satisfaction and, as a result, yields individual utility when there are feelings of moral obligation. Individuals might perceive a general obligation to support good causes and benefit from contributions for ‘whatever reason’.20 In economic valuation, such general feelings of obligation are discussed in terms of ‘a warm glow of giving’ or ‘purchase of moral satisfaction’.21,22 In addition, people may derive utility from altruistic behaviour such as independent of the fact that others will be better off. This leads to ‘impure altruism’ in the model of Andreoni21 and is termed ‘participation altruism’ in the model of Margolis.22 These are used to describe what is known as the embedding effect, that is, the observation that at times WTP does not change with the quantity of the service under consideration.22 If an individual can derive utility from the act of giving, then, it does not matter what quantity of the good is provided. It is argued that the moral satisfaction may vary with the goods such that some goods give more satisfaction than others.22 As such, WTP can be expected to be positively affected by both a ‘general warm glow’ (GWG) and subjective obligation to pay (SOP) for the specific services.23, 24, 25

CV method questions elicit WTP values that may vary based on differences in respondents' perception on preparedness level.24 In addition, individuals' perceptions of response efficacy determine the effectiveness of preparedness actions and adjustments and therefore their WTP.25

Individuals may also perceive and define their WTP as a contribution to the provision of a public good and collective action.26,27 In the framework of the theory of public goods, dilemma concern and trust in other people's cooperation can be considered as determinants of WTP.26,27 Furthermore, the norm activation model postulates that a personal norm, which leads to moral obligations regarding a specific action (e.g. paying for improving pandemic preparedness) is only activated and transformed into behaviour if certain conditions are fulfilled; this mainly consists of the awareness of need and responsibility as determinants of norm activation.28

The Theory of Planned Behaviour (TPB) proposes that attitude, subject norms, and perceived behavioural control, mutually outline an individual's behavioural intentions and behaviours. The concept is pioneered by Ajzen29 to improve on the predictive power of the theory of reasoned action30 by including perceived behavioural control. The underlying idea of the TPB is that an individual's behaviour is mainly influenced by attitudes (i.e. whether the behaviour is considered positively or negative), subjective norms (i.e. social pressure perceived by the individual to engage in a certain behaviour) and perceived behavioural control (i.e. easiness or difficulty in performing the behaviour).

Section snippets

Methods

A drop-off contingent valuation method (CVM) questionnaire was used to collect data from economically active individuals in Mauritius over the period October 2020 to December 2020. The sample consists of respondents from both urban and rural areas to ensure representativeness in the range of individuals' perspectives. 800 respondents were considered for the survey. Of the total, 732 valid survey questionnaires were gathered, whereas the rest were considered as invalid due to incomplete

Results

The results for the Probit model are presented in Table 4 in Annex 5. The result indicates that people residing in rural regions are 6.5% more likely to pay for pandemic preparedness relative to people residing in urban areas. Moreover, individuals with income between the range Rs. 20,001 to Rs. 30,000 are 9.5% less likely to pay for enhancing pandemic preparedness compared with individual with income above Rs. 40,000.

Interestingly, the coefficient of COVID-19 knowledge is positive and

Discussion

This study has estimated the WTP for enhancing pandemic preparedness in Mauritius. The results show that households are willing to pay an average of Rs. 1900 (approximately USD 50) per annum to enhance pandemic preparedness. On average, the government can potentially expect to mobilise an additional Rs. 1,047,470,000 (USD 27,565,000) from taxpayers to spend on enhancing pandemic preparedness in Mauritius. (This is extrapolated onto all of the working population).

Among the sociodemographic

Ethical approval

Not required.

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