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Since the implementation of cost recovery policies in health sectors in developing countries, recourse to health care has decreased. This explains why some countries, such as Côte d’Ivoire, have decided to establish social health insurance schemes to improve access to health services. Generally, the decision to pay contributions towards health insurance is twofold. Individuals can decide first to contribute or not and, secondly, what amount to contribute. The main objective of this paper is to compare such decision-making processes and examine whether they have an impact on willingness to pay (WTP) for the universal health insurance scheme that is to be implemented in Côte d’Ivoire. The study is based on a rural household survey conducted in south-east Côte d’Ivoire and included 367 respondents. Willingness to pay is estimated through a contingent valuation method and the determinants of WTP are obtained by performing two econometric models: a censored normal Tobit model (simultaneous decision) and a generalized Tobit model (sequential decision). We find a mean annual WTP of CFA 9,569, with a median WTP of CFA 5,000. The econometric estimations show that the two models give different results. In the censored normal Tobit results, household income is not significant, while in the generalized Tobit model household income is a significant determinant. This result suggests that a methodology that ignores the households’ decision-making processes can result in misleading policy advice.