Socio-economic and geographic differences in acceptability of community-based health insurance

Onwujekwe, Obinna; Onoka, Chima; Uguru, Nkoli; Tasie, N.; Uzochukwu, Benjamin; Kirigia, Joses Muthuri; Petu, Amos

doi:10.1016/j.puhe.2011.09.006

Cited by 12 publications

(22 citation statements)

References 3 publications

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“…Researchers in Cameroon and Nigeria have documented a clear desire on the part of less well-off households to join schemes (Table 2), and over 3000 Nigerian survey respondents stated that CBHI was an acceptable means of paying for health regardless of socioeconomic background or location [26]. Interestingly, the poorest households expressed the greatest willingness to enrol.…”

Section: Resultsmentioning

confidence: 99%

Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration

Odeyemi

2014

Int J Equity Health

101

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BackgroundNigeria has included a regulated community-based health insurance (CBHI) model within its National Health Insurance Scheme (NHIS). Uptake to date has been disappointing, however. The aim of this study is to review the present status of CBHI in SSA in general to highlight the issues that affect its successful integration within the NHIS of Nigeria and more widely in developing countries.MethodsA literature survey using PubMed and EconLit was carried out to identify and review studies that report factors affecting implementation of CBHI in SSA with a focus on Nigeria.ResultsCBHI schemes with a variety of designs have been introduced across SSA but with generally disappointing results so far. Two exceptions are Ghana and Rwanda, both of which have introduced schemes with effective government control and support coupled with intensive implementation programmes. Poor support for CBHI is repeatedly linked elsewhere with failure to engage and account for the ‘real world’ needs of beneficiaries, lack of clear legislative and regulatory frameworks, inadequate financial support, and unrealistic enrolment requirements. Nigeria’s CBHI-type schemes for the informal sectors of its NHIS have been set up under an appropriate legislative framework, but work is needed to eliminate regressive financing, to involve scheme members in the setting up and management of programmes, to inform and educate more effectively, to eliminate lack of confidence in the schemes, and to address inequity in provision. Targeted subsidies should also be considered.ConclusionsDisappointing uptake of CBHI-type NHIS elements in Nigeria can be addressed through closer integration of informal and formal programmes under the NHIS umbrella, with increasing involvement of beneficiaries in scheme design and management, improved communication and education, and targeted financial assistance.

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Section: Resultsmentioning

confidence: 99%

Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration

Odeyemi

2014

Int J Equity Health

101

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“…As the biological process of aging increased, they tended to make more investment in health in order to minimize health problems. [22][23][24][25][26][27][28] That study also found that health service use, both OPD (within 3 months) and IPD (within 1 year), had a significant impact on the WTJ. The statement is closely involved with the adverse selection issue referring to individuals with a high expectation of health problems, placing a larger premium and expenditure on insurance coverage, whereas individuals with lower costs tended to select a more moderate health care plan.…”

Section: Discussionmentioning

confidence: 96%

“…On the other hand, other studies found that age and incentive for enrolling in the scheme were positively associated with the WTJ the CBHI scheme. As the biological process of aging increased, they tended to make more investment in health in order to minimize health problems …”

Section: Discussionmentioning

confidence: 99%

Factors affecting the willingness to join community‐based health insurance (CBHI) scheme: A case study survey from Savannakhet Province, Lao P.D.R.

Bodhisane

Pongpanich²

2018

Health Planning & Management

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Summary Purpose Community‐based health insurance (CBHI) targets independent worker (self‐employed) is currently struggling with inadequate size of risk pooling, low enrollment, and high dropout rate as well as financial sustainability. The objective of this study is to find out the factors that significantly affect the CBHI enrollment incentive. The study applied cross‐sectional study design to perform situation analysis, in which the Andersen behavioral model was used as a guideline to identify preliminary characteristics that involved with enrolling incentive. Findings The model found that existence of both outpatient department (OPD) and inpatient department (IPD) health service utilization had significant impact on the CBHI enrollment, this statement is strongly related to adverse selection issues. Households resides in Kaysone Phomvihane district had higher probability of joining the scheme in comparison with relatively less‐developed Champhone district. Households with no CBHI knowledge were also more likely to enroll the scheme. Occupation was also found to be a significant factors; of which farmers and laborers had lower possibility enrollment. Conclusions Economic condition of the district has a significant impact on enrolment. However, the increase in personal income does not directly enhance the desire for enrolment. Most of the high‐income households prefer to use a local, private clinic, and foreign hospitals in Thailand or Vietnam. Households with unemployed heads had the highest possibility of enrolling. The reason is the unemployed respondents include the elderly who stay at home without performing major tasks in exchange for their living. That group of people has the highest probability of either OPD or IPD.

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“…27 Despite Ghana’s success in this effort to form and implement a nationalized health insurance policy, some challenges still undermine the policy objective of the NHIS for attaining nationwide coverage years after the introduction. 28 …”

Section: Discussionmentioning

confidence: 99%

Social deterministic factors to participation in the National Health Insurance Scheme in the context of rural Ghanaian setting

Manortey

Alder

Crookston

et al. 2014

J Public Health Africa

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The primary purpose of this study is to identify predictors of complete household enrollment into the National Health Insurance Scheme (NHIS) among inhabitants of the Barekese sub-district in the Ashanti Region of Ghana. Heads of households in 20 communities from the Barekuma Collaborative Community Project site were interviewed to gather data on demographic, socioeconomic status (SES) indicators and complete household subscription in the NHIS. Logistic regression model was used to predict enrollment in the NHIS. Of the 3228 heads of households interviewed, 60 percent reported having all members of their respective households enrolled in the NHIS. Residents in the classified Middle and High SES brackets had 1.47 (95% CI: 1.21-1.77) and 1.66 (95% CI: 1.27-2.16) times higher odds, respectively, of complete household enrollment compared to their counterparts in the Low SES category. The odds of enrolling in the program tend to increase progressively with the highest level of education attained by the head of the family unit. Eight years after the introduction of the national health insurance policy in Ghana, the reported subscription rate for complete households was about 60 percent in the 20 rural communities that participated in the study. This finding calls for the need to step up further national strategies that will help increase enrollment coverage, especially among the poor and less educated in the rural communities.

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Socio-economic and geographic differences in acceptability of community-based health insurance

Cited by 12 publications

References 3 publications

Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration

Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration

Factors affecting the willingness to join community‐based health insurance (CBHI) scheme: A case study survey from Savannakhet Province, Lao P.D.R.

Social deterministic factors to participation in the National Health Insurance Scheme in the context of rural Ghanaian setting

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