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

Umeh, Chukwuemeka A.; Feeley, Frank G.

doi:10.9745/ghsp-d-16-00286

Cited by 67 publications

(69 citation statements)

References 60 publications

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“…Contrary to the government's aim of making CBHI schemes accessible and affordable by the poor by subsidizing premiums, the magnitude of the impacts in terms of reducing out-ofpocket expenditure are higher for the richer households. This is in line with previous findings that the CBHI do no favor the poor in the relative reduction in out-of-pocket expenditure (Umeh and Feeley, 2017;Schneider and Diop, 2001) In general, the results are robust to different model specifications and, not surprisingly, present overwhelming evidence of selection on observed and unobserved factors.…”

Section: Introductionsupporting

confidence: 91%

The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda

Woldemichael

Gurara

Shimeles³

2019

IMF Working Papers

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Section: Introductionsupporting

confidence: 91%

The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda

Woldemichael

Gurara

Shimeles³

2019

IMF Working Papers

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“…However, equity is not a natural consequence of the implementation of UHC policies. On the contrary, the pursuance of UHC implies trade-offs which are not necessarily favourable to vulnerable people, and some policies pursued in the name of UHC may worsen inequalities [5][6][7][8]. Hence the acknowledged importance of measuring inequity, and tracking progress in this regard when implementing UHC policies [9,10].…”

Section: Introductionmentioning

confidence: 99%

How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal

Paul

Deville

Bodson

et al. 2019

Int J Equity Health

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Background: Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. Methods: We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. Results: Most of the documents analysed do not define equity in the first place, and speak about "health inequities" in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguousespecially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rightsbut also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socioeconomic , geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. Conclusions: While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.

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“…Beyond the enormous disparities between policies or programmes, there are similarities, if not sameness, between the solutions sought in very different contexts. For example, the "mutuelles communales" that exist in over 1,750 French municipalities seem quite similar to community-based health insurance (CBHI) programmes developed in low-and middle-income countries (13). In both cases, a mutual benefit principle applies, even if the contractual arrangements necessarily differ (in particular, the abolition of insurance premiums for the most disadvantaged, which is one of the strengths of CBHI programmes).…”

Section: Healthcare Access: Availability Accessibility Acceptabilitymentioning

confidence: 99%

“…In particular, the transfer of the processing of applications for residence permits for healthcare, from the Ministry of Health to the Ministry of Home Affairs, has been criticized (25). While the integration of State medical aid (AME 13 ) into the PUMa through access to complementary universal health coverage (CMUC) 14 proposed for several years now by the general inspectorates of social work and of finance, and the national agency for the protection of citizens' rights -continues to be delayed, the PFIDASSs 11 Centres d'hébergement et de réinsertion sociale 12 Protection universelle maladie 13 Aide médicale d'Etat 14 Couverture maladie universelle Complémentaire mission seems to be contingent on the varying conditions applied to the different categories of foreign nationals and the pressures from certain partners.…”

Section: A Framework That Does Not Take Into Account the Need For Lonmentioning

confidence: 99%

Waiting for common-law solutions for the most vulnerable populations’ healthcare access

Warin

2019

Revue d'Épidémiologie et de Santé Publique

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Position du problème L'état de santé des populations est lié à leur accès à des soins de santé de qualité. Réaliser au mieux cette condition principale -sanitaire, sociale et humanitaire -est un objectif permanent de politique publique. Beaucoup d'efforts sont réalisés. Mais intègrent-ils autant qu'il le faudrait l'état de santé des populations les plus vulnérables ? En France, la réduction du phénomène du renoncement à des soins est un axe prioritaire de la politique actuelle de l'Assurance maladie. Dans le cadre des Plans locaux d'accompagnement du non-recours, des incompréhensions et des ruptures (PLANIR), cette institution est en train de généraliser un dispositif d'intervention territorial et partenarial dans le but d'éviter que les assurés sociaux renoncent à des soins. Cet investissement social est sans précédent. Pour autant, l'impact du dispositif sur les populations les plus vulnérables paraît limité pour le moment.Méthode L'examen de cet exemple repose sur le suivi de la généralisation du dispositif en question. Ce suivi a été confié à l'équipe de recherche cofondée par l'auteur (l'Observatoire des non-recours aux droits et services). ConclusionLes difficultés pour intégrer les plus vulnérables dans un dispositif de droit commun comme celui proposé par l'Assurance maladie ne paraissent pas insurmontables. Mais à la condition que l'autorité de régulation (les Agences régionales de santé) ait la volonté et la possibilité d'en faire un objectif stratégique organisationnel au plan local. Mots clésAccès aux soins. Populations vulnérables. Dispositifs de droit commun. Assurance maladie. Urgence sociale.

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

Abstract: The poor lack equitable access to health care in community-based health insurance schemes. Flexible installment payment plans, subsidized premiums, and elimination of co-pays can increase enrollment and use of health services by the poor.

Cited by 67 publications

References 60 publications

The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda

The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda

How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal

Waiting for common-law solutions for the most vulnerable populations’ healthcare access

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