scholarly journals Socioeconomic inequality in premiums for a community-based health insurance scheme in Rwanda

2020 ◽  
Author(s):  
Gowokani Chijere Chirwa ◽  
Marc Suhrcke ◽  
Rodrigo Moreno-Serra
Keyword(s):  
Gender Differences ◽  
Health Insurance ◽  
Socioeconomic Inequality ◽  
Decomposition Analysis ◽  
Health Financing ◽  
Policy Implications ◽  
Community Based ◽  
Flat Rate ◽  
Community Based Health Insurance ◽  
Quantile Regression Decomposition

Abstract Community-based health insurance (CBHI) has gained popularity in many low- and middle-income countries, partly as a policy response to calls for low-cost, pro-poor health financing solutions. In Africa, Rwanda has successfully implemented two types of CBHI systems since 2005, one of which with a flat rate premium (2005–10) and the other with a stratified premium (2011–present). Existing CBHI evaluations have, however, tended to ignore the potential distributional aspects of the household contributions made towards CBHI. In this paper, we investigate the pattern of socioeconomic inequality in CBHI household premium contributions in Rwanda within the implementation periods. We also assess gender differences in CBHI contributions. Using the 2010/11 and 2013/14 rounds of national survey data, we quantify the magnitude of inequality in CBHI payments, decompose the concentration index of inequality, calculate Kakwani indices and implement unconditional quantile regression decomposition to assess gender differences in CBHI expenditure. We find that the CBHI with stratified premiums is less regressive than CBHI with a flat rate premium system. Decomposition analysis indicates that income and CBHI stratification explain a large share of the inequality in CBHI payments. With respect to gender, female-headed households make lower contributions towards CBHI expenditure, compared with male-headed households. In terms of policy implications, the results suggest that there may be a need for increasing the premium bracket for the wealthier households, as well as for the provision of more subsidies to vulnerable households.

scholarly journals Feasibility and Desirability of Scaling up Community –based Health Insurance (CBHI) in rural communities in Uganda. Lessons from Kisiizi hospital CBHI scheme.

2019 ◽  
Author(s):  
ALEX KAKAMA AYEBAZIBWE
Keyword(s):  
Health Insurance ◽  
Health Financing ◽  
Scaling Up ◽  
Healthcare Services ◽  
Community Based ◽  
Leadership And Management ◽  
Community Based Health Insurance ◽  
Community Associations ◽  
Key Informant

Abstract Background Community-based health Insurance (CBHI) schemes have been implemented world over as initial steps for National Health Insurance. The CBHI concept developed out of a need for financial protection against catastrophic health expenditure to the poor after failure of other health financing mechanisms. CBHI schemes reduce out-of-pocket payments, and improve access to healthcare services in addition to raising additional revenue for health sector. Kisiizi hospital CBHI scheme has 41,500 registered members since 1996, organised in 210 community associations known as ‘Bataka’ or ‘Engozi’ societies. Members pay annual premium fees and a co-payment fee before service utilisation. This Study aimed at exploring the feasibility and desirability of scaling up CBHI in Rubabo County, with objectives of; exploring community perceptions and determining acceptability of CBHI, identifying barriers and enablers to scaling up CBHI and documenting lessons regarding CBHI expansion in a rural community. Method: Explorative study using qualitative methods. Key informant interviews and Focus Group Discussions (FGD) were used in data collection. Twenty two key informant interviews were conducted using semi-structured questionnaires. Three FGD for scheme members and three for non-scheme members were conducted. Data was analysed using thematic approach. Results : Scaling up Kisiizi hospital CBHI is desirable because: it conforms to the government social protection agenda, conforms to society values, offers a comprehensive benefits package, and is a better healthcare financing alternative for many households. Scaling up Kisiizi hospital CBHI is largely feasible because of a strong network of community associations, trusted quality of services at Kisiizi Hospital, affordable insurance fees, and trusted leadership and management systems. Scheme expansion faces a few obstacles: long distances and high transport costs to Kisiizi hospital, low levels of knowledge about insurance, overlapping financial priorities at household level and inability of some households to pay insurance fees. Conclusions CBHI implementation requires the following considerations: Conformity with society values and government priorities, a comprehensive benefits package, trusted quality of healthcare services, affordable fees, and trusted leadership and management systems. Key words Community-based Health Insurance, Universal Health Coverage, Health financing, Enrolment

Pooled coverage of community based health insurance scheme enrolment in Ethiopia: Systematic review and meta-analysis. (Preprint)

2021 ◽  
Author(s):  
Ahmed Tahir ◽  
Abdilahi Omer ◽  
Abdifatah Elmi
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Access To Health Care ◽  
Meta Analysis ◽  
Group Analysis ◽  
Policy Implications ◽  
Test Statistic ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Manual Search

BACKGROUND Community Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. OBJECTIVE The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications. METHODS The systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I2 test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model. RESULTS Among 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97(95%CI: 41.68, 69.77) in earlier (2016-2017) studies than recent 37.33(95%CI: 24.82, 50.77) studies (2018-2020). CONCLUSIONS The pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages. CLINICALTRIAL Registration: the protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762

scholarly journals Barriers and facilitators of community based health insurance membership in rural Amhara region, northwest Ethiopia: A qualitative study

2019 ◽  
Author(s):  
Getu Debalkie Demissie ◽  
Asmamaw Atnafu
Keyword(s):  
Health Insurance ◽  
Health Financing ◽  
Northwest Ethiopia ◽  
Amhara Region ◽  
Community Based ◽  
Main Research ◽  
Low Level ◽  
Community Based Health Insurance ◽  
Out Of Pocket Payments ◽  
Key Informant

Abstract Background: More than 150 million people encounter huge cost of health expenses every year, and most of these treatment seekers face poverty owing to out of pocket payments. Community-based health insurance won popularity as a makeshift health financing mechanism for out of pocket payments in poor communities. The aim of this study was to identify the facilitators and impediments of enrollment to community based health insurance in rural parts of the Amhara region, Ethiopia.Method: Focus group discussions (FGD) were the main research methodology supplemented by key informant interviews (KII). The FGD participants were selected by purposive sampling techniques based on the membership status of CBHI (members or non-members). Six FGDs and four key informant interviewees were conducted in March 2018 in three districts. Before analyzing the data, all FGDs and KIIs were transcribed and transferred into Atlasti version 7.1 software. Thematic analysis was done according to key themes arising from the data. Results: Low level of awareness, perception of high amount of premium, poor perception of quality of services and lack of trust in community based health insurance are the barriers to membership in community based health insurance.Conclusion: There has been a low level of awareness and misconception about community based health insurance. The major reason for not joining CBHI was incapacity to pay the premium.

scholarly journals The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ramadhani Kigume ◽  
Stephen Maluka
Keyword(s):  
Health Insurance ◽  
Community Health ◽  
Rural Areas ◽  
Health Coverage ◽  
Access To Health Services ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Urban Districts ◽  
Health Fund ◽  
The Government

Abstract Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.

scholarly journals Impact of community-based health insurance on utilisation of preventive health services in rural Uganda: a propensity score matching approach

2021 ◽  
Author(s):  
Emmanuel Nshakira-Rukundo ◽  
Essa Chanie Mussa ◽  
Nathan Nshakira ◽  
Nicolas Gerber ◽  
Joachim von Braun
Keyword(s):  
Developing Countries ◽  
Health Insurance ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Information Diffusion ◽  
Preventive Health ◽  
Financial Protection ◽  
Community Based ◽  
Research Attention ◽  
Community Based Health Insurance

AbstractThe effect of voluntary health insurance on preventive health has received limited research attention in developing countries, even when they suffer immensely from easily preventable illnesses. This paper surveys households in rural south-western Uganda, which are geographically serviced by a voluntary Community-based health insurance scheme, and applied propensity score matching to assess the effect of enrolment on using mosquito nets and deworming under-five children. We find that enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%. We postulate that these findings are partly mediated by information diffusion and social networks, financial protection, which gives households the capacity to save and use service more, especially curative services that are delivered alongside preventive services. This paper provides more insight into the broader effects of health insurance in developing countries, beyond financial protection and utilisation of hospital-based services.

scholarly journals Preferences for benefit packages for community-based health insurance: an exploratory study in Nigeria

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Obinna Onwujekwe ◽  
Chima Onoka ◽  
Nkoli Uguru ◽  
Tasie Nnenna ◽  
Benjamin Uzochukwu ◽  
...  
Keyword(s):  
Health Insurance ◽  
Exploratory Study ◽  
Community Based ◽  
Community Based Health Insurance
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