Adoption of Mobile health Insurance Systems in Africa: evidence from Cameroon
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ORIGINAL PAPER
Adoption of Mobile health Insurance Systems in Africa: evidence from Cameroon Ndifon Mark Ndifon 1 & Ransome Epie Bawack 2
&
Jean Robert Kala Kamdjoug 1
Received: 9 September 2019 / Accepted: 29 June 2020 # IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The cost of health care services remains central concerns in low- and middle-income countries (LMIC), especially in Africa. One of the major challenges they face is how to efficiently reduce out-of-pocket spending. Health insurance systems are either inexistent or inefficient in many of these countries. In an attempt to implement and improve these systems, several countries have implemented mobile-supported health insurance systems (MHIS). Unfortunately, most of these programs have not crossed the pilot phases because of low adoption rates. Thus, this study sought to investigate the factors that influence the adoption of MHIS in LMIC. Using 263 valid responses collected during a 3-month survey in Cameroon, we found that coping appraisal and technology appraisal are important for the adoption of MHIS in LMIC. Precisely, performance expectancy, self-efficacy, response efficacy, facilitating conditions, and perceived cost explain 57.7% of the variance in behavioral intention to adopt MHIS. This study is based on empirically tested factors founded on the protection motivation theory (PMT) and the unified theory of acceptance and use of technology (UTAUT). Our contributions target health economists, technologists, policymakers, managers, researchers, and anyone interested in understanding the behavior of health insurance service consumers in LMIC and the pressures insurers and governments face during MHIS programs. We discuss the implications of our findings and further research that could help further explain MHIS adoption in LMIC. Keywords mHealth . Health insurance . PMT . UTAUT . Performance expectancy . Response efficacy
1 Introduction At least half of the world’s population cannot afford complete essential health care services and must rely on assistance from their national health systems (NHS). Many of the few individuals who try doing so by themselves experience excessive financial difficulties or eventually become impoverished because they spent over 25% of their household budget paying for these services [1]. However, low- and middle-income countries (LMIC) especially those on the African continent
* Ransome Epie Bawack [email protected] 1
Catholic University of Central Africa, 11628 Yaoundé, Cameroon
2
TBS Business School, University of Toulouse Capitole, 2 rue du Doyen Gabriel Marty, 31042 Toulouse Cedex 9, France
face the biggest challenges as concerns health spending and financing. Out-of-pocket (OOP) spending in high-income countries like France (6.8%) and the USA (11.1%) were low meanwhile those in LMIC like Cameroon (69.7%) and Nigeria (72.2%) were very high [2]. This is due to the ineffectiveness of the health systems in LMIC which limits their ability to ensure universal health cov
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