Low rural health insurance take-up in a universal coverage system: perceptions of health insurance among the uninsured in La Guajira, Colombia

Abstract

Despite enacting a universal healthcare system in 1993, many Colombians do not participate. Understanding perceptions of the system could help the government market certain features or adjust benefits in order to increase enrollment. Using La Guajira, Colombia, as a case study, we surveyed uninsured rural households regarding insurance preferences, values and beliefs, and perceptions of available services. Four hundred heads of households responded in La Guajira, Colombia. Respondents reported high levels of long-term uninsurance. Overall, the quality of services in the government-run system is perceived as better than being uninsured, but there appear to be constraints on enrollment. Rural Colombians value more family coverage and better choice of physicians, but offering better benefits may not be enough. Many cited access barriers, so reducing these barriers may also increase enrollment. Further surveys in other parts of Colombia should be undertaken to confirm results.

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

“…Perceptions about different aspects of health insurance generally play an important role in how individuals make decisions to enrol and utilise services. 22,53-56 , The perceptions presented here follow the classification of Jehu-Appiah and colleagues. 22 In particular, we explore perceptions regarding management of the scheme, financial protection, health beliefs, social influence, the convenience of scheme processes, quality of health services and premiums.…”

Inequities in cervical cancer screening among Colombian women: A multilevel analysis of a nationwide survey

“…Not having health insurance is also a critical factor for not having a Pap test [15,25], especially in rural areas [15]. Barriers for enrolling, co-payments established by health insurance companies, or lack of specialists are difficulties faced by rural people with no insurance in Colombia [39]. Additionally, Pap screening in the Atlantic and Amazon-Orinoquía regions is particularly poor [40], especially in rural areas, as we identified.…”

Identifying barriers to move to better health coverage: preferences for health insurance benefits among the rural poor population in La Guajira, Colombia

“…Upon asking about the most important health insurance policy attributes among 15 options, which the subsidized health insurance policy‐affiliated population would choose in new health insurance coverage, there was greater preference for coverage of family members, the option to choose a doctor and/or a hospital, and access to specialists. The population gave little importance to financial attributes for choosing health insurance, which was consistent with the findings in the urban area (Trujillo et al ., ) and among the uninsured population of the rural area (Buttorff et al ., ) in Colombia.…”

“…In the rural area of La Guajira, Buttorff et al . () evidenced that the reasons for which the uninsured poor rural population is not affiliated to the subsidized health insurance policy are associated with administrative obstacles more than with financial barriers. The persons who took the survey preferred to be outside the healthcare system because they received no enrollment help nor did they have political connections that would enable them to expedite the selection and affiliation process.…”

“…It is worth highlighting two studies conducted in Colombia in the past 2 years. One was conducted on uninsured households and on subsidized health insurance policy-affiliated households in urban Bogotá (Trujillo et al, 2012), and the other was conducted on the uninsured rural population in the provincial department of La Guajira (Buttorff et al, 2013). Results showed that chronic disease coverage and family protection were the aspects most valued by the poor population under the subsidized health insurance policy as well as by the uninsured in the urban area; the poor population in the rural area gave priority to flexibility in choosing doctors and to family coverage.…”