scholarly journals Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

2014 ◽  
Vol 107 ◽  
pp. 78-88 ◽  
Author(s):  
Philipa Mladovsky
Keyword(s):  
Health Insurance ◽  
Household Survey ◽  
Drop Out ◽  
Community Based ◽  
Community Based Health Insurance

Determinants Perception and Experiences of Beneficiaries of a Hospital-based Community Health Insurance in Coastal Karnataka in India

2017 ◽  
Vol 19 (2) ◽  
pp. 244-254 ◽  
Author(s):  
Bhageerathy Reshmi ◽  
Sreekumaran Nair ◽  
Bhaskaran Unnikrishnan
Keyword(s):  
Health Insurance ◽  
Risk Sharing ◽  
Group Discussion ◽  
Health Care Financing ◽  
Preventive Treatment ◽  
Household Survey ◽  
Community Based ◽  
Cross Sectional ◽  
Community Based Health Insurance ◽  
Study Results

The objective of this study was to find out the perceptions of beneficiaries in comparison to non-beneficiaries of a community-based health insurance scheme. Both quantitative and qualitative methods were used to carry out this study; a cross-sectional household survey on 1,639 households was carried out, where the respondents were required to rate the services and facilities of the scheme A focus group discussion (FGD) with both the beneficiaries and non-beneficiaries was also carried out. Overall, the services were rated good except in the case of treatment and inpatient services where the responses were rated average. The study results provide evidence that Community Based Health Insurance (CBHI) schemes can be a viable risk sharing mechanism for the informal sector people who would have otherwise not been covered under any health insurance or health care financing mechanism. Maintaining an affordable premium and including outpatient facilities and preventive treatment would improve the satisfaction level of those who have acceptability towards CBHI schemes.

Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso

Health Policy ◽  
2009 ◽  
Vol 92 (2-3) ◽  
pp. 174-179 ◽  
Author(s):  
Hengjin Dong ◽  
Manuela De Allegri ◽  
Devendra Gnawali ◽  
Aurélia Souares ◽  
Rainer Sauerborn
Keyword(s):  
Health Insurance ◽  
Burkina Faso ◽  
Drop Out ◽  
Community Based ◽  
Community Based Health Insurance

scholarly journals Continued Adherence to Community-Based Health Insurance Scheme in Two Districts of Northeast Ethiopia: Application of Accelerated Failure Time Shared Frailty Models

2021 ◽  
Author(s):  
Mohammed Hussien ◽  
Muluken Azage ◽  
Negalign Berhanu Bayou
Keyword(s):  
Health Insurance ◽  
Failure Time ◽  
Multivariable Analysis ◽  
Drop Out ◽  
Accelerated Failure Time ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Shared Frailty ◽  
Risk Protection

Abstract Background: The sustainability of a voluntary community-based health insurance scheme depends to a greater extent on its ability to retain members. In low- and middle-income countries, high rate of member dropout has been a great concern for such schemes. Although few studies had investigated the factors influencing dropout decisions, none of these looked into how long and why members adhere to the scheme. The purpose of this study was to determine the factors affecting time to drop out while accounting for the influence of cluster-level variables. Methods: A community-based cross-sectional study was conducted among 1232 rural households who have ever been enrolled in two community-based health insurance schemes. A household survey was conducted using a mobile data collection platform. The Kaplan-Meier estimates were used to compare the time to drop out among subgroups. To identify predictors of time to drop out, a multivariable analysis was done using the accelerated failure time shared frailty models. The degree of association was assessed using the acceleration factor (δ) and statistical significance was determined at 95% confidence interval. Results: Results of the multivariable analysis revealed that marital status of the respondents (δ=1.614; 95% CI: 1.221–2.134), household size (δ=1.167; 95% CI: 1.012–1.344), presence of chronic illness (δ=1.421; 95% CI: 1.163–1.736), hospitalization history (δ=1.308; 95% CI: 1.120–1.529), higher perceived quality of care (δ=1.323; 95% CI: 1.101–1.589), perceived risk protection (δ=1.220; 95% CI: 1.029–1.446), and higher trust in the scheme (δ=1.729; 95% CI: 1.428–2.095) were significant predictors of time to drop out at p-value < 0.05. Conclusions: The study identified evidence suggestive of adverse selection in the schemes. The fact that larger households remain in the scheme indicates the need to reconsider the premium level in line with household size to attract small size households. Issues that are under the control of the scheme and the healthcare system can be adjusted to increase membership adherence. Resolving problems related to the quality of health care can be a cross-cutting area of ​​intervention to retain members by building trust in the scheme and enhancing the risk protection ability of the schemes.

scholarly journals Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253368
Author(s):  
Emmanuel Nshakira-Rukundo ◽  
Essa Chanie Mussa ◽  
Min Jung Cho
Keyword(s):  
Health Insurance ◽  
Quantitative Research ◽  
Cross Sectional Study ◽  
Drop Out ◽  
Dropping Out ◽  
Health Coverage ◽  
Community Based ◽  
Cross Sectional ◽  
Community Based Health Insurance ◽  
Western Uganda

Aim Community Based Health Insurance (CBHI) schemes have become central to health systems financing as avenues of achieving universal health coverage in developing countries. Yet, while emphasis in research and policy has mainly concentrated on enrolment, very little has been apportioned to high rates of dropping out after initial enrolment. The main aim of this study is to understand the factors behind CBHI dropping out through a cross-sectional quantitative research design to gain insights into curtailing the drop out of CBHI in Uganda. Methods The survey for the quantitative research component took place between August 2015 and March 2016 covering 464 households with under-5 children in south-western Uganda. To understand the factors associated with dropping out of CBHI, we employ a multivariate logistic regression on a subsample of 251 households who were either currently enrolled or had enrolled at one time and later dropped out. Results Overall, we find that 25.1 percent of the households that had ever enrolled in insurance reported dropping out. Household socioeconomic status (wealth) was one of the key factors that associated with dropping out. Larger household sizes and distance from the hospital were significantly associated with dropping out. More socially connected households were less likely to drop out revealing the influence of community social capital in keeping households insured. Conclusion The findings have implications for addressing equity and inclusion concerns in community-based health insurance programmes such as one in south-western Uganda. Even when community based informal system aim for inclusion of the poorest, they are not enough and often the poorest of the poor slip into the cracks and remain uninsured or drop out. Moreover, policy interventions toward curtailing high dropout rates should be considered to ensure financial sustainability of CBHI schemes.

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

Evaluating the Impact and Effectiveness of Community-Based Health Insurance Policy Among Informal Sector in Lagos State Using Donabedian Model

2021 ◽  
Vol 5 (2) ◽  
pp. 65-80
Author(s):  
Afeez Kolawole Shittu ◽  
Kikelomo Aboyowa Mbada ◽  
Temitayo Isaac Odeyemi
Keyword(s):  
Health Insurance ◽  
Informal Sector ◽  
Urban Areas ◽  
National Level ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Healthcare Needs ◽  
Lagos State ◽  
Donabedian Model ◽  
The Impact

The study used the Donabedian model (process, structure, and outcome) to evaluate the impact and effectiveness of the Community Based Health Insurance Scheme (CBHIS) among informal sector population in rural and semi-urban areas of Lagos State, and the respondents were drawn among the market men and women, motorist, among others. Three hundred and eighty-four (384) respondents were sampled based on the research advisor's sampling size. Lagos State is stratified along with its three senatorial districts and a local government each is purposively selected based on the full implementation of CBHIS. Data were analysed using descriptive and interferential statistics and the result revealed that 55% of respondents attested to the effectiveness of CBHIS in drastically reducing the cost of medical services and enhancing equal accessibility for healthcare needs. On the other hand, the implementation of CBHIS has no significant impact on healthcare service delivery due to the unfriendly attitude of healthcare providers towards the beneficiaries. The study concluded by providing information on the outcomes of CBHIS implementation at the sub-national level of government in Nigeria and suggest ways of improvement.

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