A Model to Estimate the Impact of Thresholds and Caps on Coverage Levels in Community-based Health Insurance Schemes in Low-Income Countries

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.

Download Full-text

The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228558 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8558

Author(s):

Zemzem Shigute ◽

Anagaw D. Mebratie ◽

Robert Sparrow ◽

Getnet Alemu ◽

Arjun S. Bedi

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Quality Of Care ◽

Health Insurance ◽

Access To Health Care ◽

Sub Saharan Africa ◽

Community Based ◽

Community Based Health Insurance ◽

The Impact

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Africa.

Download Full-text

The Impact of Community Based Health Insurance in Enhancing Better Accessibility and Lowering the Chance of Having Financial Catastrophe Due to Health Service Utilization

International Journal of Health Services ◽

10.1177/0020731415595609 ◽

2015 ◽

Vol 47 (3) ◽

pp. 504-518 ◽

Cited By ~ 8

Author(s):

Somdeth Bodhisane ◽

Sathirakorn Pongpanich

Keyword(s):

Health Care ◽

Health Insurance ◽

Household Income ◽

Health Care Services ◽

Lower Probability ◽

Community Based ◽

Cross Sectional ◽

Community Based Health Insurance ◽

Care Services ◽

The Impact

The Lao population mostly relies on out-of-pocket expenditures for health care services. This study aims to determine the role of community-based health insurance in making health care services accessible and in preventing financial catastrophe resulting from personal payment for inpatient services. A cross-sectional study design was applied. Data collection involved 126 insured and 126 uninsured households in identical study sites. Two logistic regression models were used to predict and compare the probability of hospitalization and financial catastrophe that occurred in both insured and uninsured households within the previous year. The findings show that insurance status does not significantly improve accessibility and financial protection against catastrophic expenditure. The reason is relatively simple, as catastrophic health expenditure refers to a total out-of-pocket payment equal to or more than 40% of household income minus subsistence. When household income declines as a result of inability to work due to illness, the 40% threshold is quickly reached. Despite this, results suggest that insured households are not significantly better off under community-based health insurance. However, compared to uninsured households, insured households do have better accessibility and a lower probability of reaching the financial catastrophe threshold.

Download Full-text

Community Based Health Insurance Enrollment and Associated Factors in Sidama Region, Ethiopia

10.21203/rs.3.rs-121840/v1 ◽

2020 ◽

Author(s):

Berhanu Bifato ◽

Amanuel Ayele ◽

Muse Rike ◽

Dalecha Dangura

Keyword(s):

Health Insurance ◽

Confidence Interval ◽

Low Income ◽

Associated Factors ◽

Statistical Significance ◽

Multivariable Analysis ◽

P Value ◽

Community Based ◽

Community Based Health Insurance ◽

Insurance Enrollment

Abstract Background: Community based health insurance is accepted as a capable tool of health system improvement and improves the health status of enrollees. Its mechanisms look for to protect low-income households from health related risks through mutual risk sharing at the community level. Even though Government’s efforts, the Community based health insurance enrolment rate remained low. Objective: To assess the community based health insurance enrollment and associated factors in Sidama Region, Ethiopia.Methods: A community based cross-sectional study was conducted in Sidama Region, 2020 using a pretested structured questionnaire. The study was conducted in randomly selected 770 households. The data entry was made by using Epi-info 2007 software. The data was analyzed by using SPSS version 20. Logistic regression statistical model was used to compute odds ratio with its 95% confidence interval to test the associations between dependent and independent variables. Then variables found to have P<0.25 in the bi-variable analysis taken as candidate for multivariable analysis. A P-value of 0.05 with a confidence interval of 95% was used to declare level of statistical significance. Result: Among 770 sampled households, 762 were interviewed and the response rate was 98.9%. About 20.2% of the respondents were enrolled in the scheme. Covariates such as፡ ages 31-59 years(AOR :2.62, 95% CI :1.48-4.66)and >=60 years(AOR : 2.87, 95% CI :1.23-6.74), households who had no formal education(AOR:1.66, 95% CI:1.02-2.72),affordability of premium (AOR:0.28, 95% CI: 0.15-0.54), knowledge on CBHI(AOR: 3.53; 95% CI: 1.21, 10.27) and perceived quality(AOR: 0.52, 95% CI: 0.25-0.87) had statistically significant association with community based health insurance enrollment.Conclusion: The prevalence of community based health insurance enrollment was low. This study identified the need to create knowledge and bring behavioral change in the community on the scheme in general. This study also revealed that regular contribution issue needs improvement based on affordability of households and building their trust on the program and efforts should be devoted to enhance quality of healthcare services to increase the enrollment.

Download Full-text

Determinants of Community-Based Health Insurance Scheme Enrolment in Developing Countries: A Systematic Review

Asian Journal of Advanced Research and Reports ◽

10.9734/ajarr/2019/v5i330131 ◽

2019 ◽

pp. 1-14 ◽

Cited By ~ 1

Author(s):

G. T. Olowe

Keyword(s):

Developing Countries ◽

Health Insurance ◽

Low Income ◽

Mixed Method ◽

Community Based ◽

Quality Healthcare ◽

Thematic Synthesis ◽

Community Based Health Insurance ◽

The People ◽

The Third World

In developing Nations, the Community-based Health Insurance (CBHI) scheme is a potential approach to increasing access to quality healthcare. It has the potency of generating financial resources for health services; plus improve on the standard of life of the people. Evidence based reports suggest that enrolment into the CBHI is still low, particularly among low income earners of the third world nations. Thus, this study was undertaken to review and help formulate policies by existential evidence on the factors that determines enrolment into the CBHI in developing countries. Study adopted the thematic synthesis of both qualitative and mixed method studies that report the above measure of interest. Study relied on Ovid Medline In-Process and other Non-Indexed citations till present. Study sourced the web of Knowledge, Google Scholar for articles relating to enrolment into CBHI in developing countries. Six studies (qualitative and mixed method studies) reporting qualitative results on the factors determining enrolment into CBHI in developing countries met the inclusion criteria. Quality assessment was carried out on each study and findings were synthesised with the aid of thematic synthesis. Four major themes were identified by interpreting and categorizing the themes across all selected studies; Individual factors, Scheme factors, Service provider factors and Requirement to team up with others before enrolment. In the end, study observed enrolment into CBHI scheme in developing countries to be driven by several factors including age and policy making, most of which positively or negatively influence decisions made by households to enrol or not in the CBHI scheme. Findings from this review are expected to contribute to policy and decision making for health care centres under CBHI scheme in developing countries.

Download Full-text