Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso

Abstract

The CBHI scheme in this case was only partially successful in achieving the equity objectives. This study advises policy makers in Burkina Faso and elsewhere, who see CBHI schemes as a silver bullet to achieve universal health coverage, to be mindful of the chronically low enrolment rates and more importantly the lack of equity across the various groups that this study has highlighted.

The Impact of Healthcare Insurance on the Utilisation of Facility-Based Delivery for Childbirth in the Philippines

“…Our results also suggest that for poor and rural women, having access to insurance led to increased utilization of FBD. Similar findings have been reported in other countries with regards to institutional delivery [53–55] as well as other healthcare services [56–59]. In settings with persistent inequities, however, it is paramount that disadvantaged groups of the population are targeted in the scale-up of social insurance, as the Philippines has done, and that these reforms are complemented by programmes addressing other barriers to healthcare access (ie physical and cultural barriers)…”

Inequitable Access to Health Care by the Poor in Community-Based Health Insurance Programs: A Review of Studies From Low- and Middle-Income Countries

“…Studies conducted in Burkina Faso, 27 , 51 Senegal, 8 , 52 the Philippines, 53 Uganda, 54 , 55 and Mali 56 support this finding. In Burkina Faso, the poor were 73% less likely to enroll in CBHI than the rich 51 . Another study in Burkina Faso showed that the rich were more likely to be insured than the poor, with the median household expenditure (a proxy for household wealth) 2.6 times higher among those who were insured than among the uninsured 27 .…”

“…In addition, household wealth quintiles in Mali did not show any consistent pattern of association with use of health services among those enrolled in the mutual health organization 56 . Furthermore, studies in Burkina Faso and Rwanda showed that for the most part enrollment in CBHI schemes led to increased utilization of health services among the enrolled compared with the unenrolled 51 , 57 , 62 . However, a study in Senegal did not find any difference in utilization between the insured and uninsured 63 .…”

“…Studies in Burkina Faso showed that rich enrollees used health care more than poor enrollees 51 , 62 . In Burkina Faso, the poor who were enrolled in the CBHI scheme had a 50% lower odds of using health services compared with the rich who were enrolled in the scheme 51 .…”

Analysis of the implementation of a social protection initiative to admit the poorest of the poor to mutual health funds in Burkina Faso

“…Research on community insurance in the town of Nouna in the province of Kossi found that fewer poor people were registered than others because they lacked the financial capacity to pay the admission fee (De Allegri, Sanon and Sauerborn, ; Dong et al, ). An improvement in the use of outpatient services was observed only among wealthy households (Gnawali et al, ; Hounton, Byass and Kouyate, ; Parmar et al, ). A subsidy of 50 per cent of the cost of the admission fee was accordingly introduced for the poorest.…”