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 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

scholarly journals The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh

2019 ◽  
Vol 12 (4) ◽  
pp. 287-298 ◽  
Author(s):  
Jahangir A M Khan ◽  
Sayem Ahmed ◽  
Marufa Sultana ◽  
Abdur Razzaque Sarker ◽  
Sanchita Chakrovorty ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Coverage ◽  
Community Based ◽  
Quality Healthcare ◽  
Informal Workers ◽  
Community Based Health Insurance ◽  
Out Of Pocket Payments ◽  
Significant Difference ◽  
Case Comparison ◽  
Quasi Experimental

Abstract Background We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh. Methods A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates. Results The OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones. Conclusions The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.

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