Abstract
Access to healthcare services are an essential for maintaining and improving health of citizen. Good health is a key to sustained economic, social development and poverty reduction. Universal health coverage means that all people have equitable access to health services, improved quality of health services, and financial-risk protection. Community Based Health Insurance (CBHI) schemes are expected as a transitional mechanism to achieving universal coverage for health care in developing countries. CBHI schemes are characterized as hybrid arrangement from both traditional risk-sharing and formal health insurance policies. CBHI schemes are built upon the principles of social solidarity and common benefits to provide financial protection against medical expenses. To assess the ability of such schemes in meeting objectives of UHC, this study aims to systematically reviews of the existing theoretical literatures and empirical evidence on three outcomes; conceptual definition, characteristics of the scheme, and challenges to the success of the community based health insurance in developing counties . The study employed a qualitative research methodology by applying the basic principles of a systematic review in order to assess the existing literatures on the effectiveness and challenges of CBHI schemes in developing countries. This study totally relies on secondary sources which were collected from published works on journals, newspapers, published and unpublished articles of credible and reliable online sources. The review of literatures shows that the major challenges of the schemes are adverse selection, limited risk pool, poor financial risk protection, lack availability and quality of services, and lack of professional and standardized management. To overcome the challenges, all possible solutions were recommended. Keywords : Community-based health insurance, Universal health coverage, Rural, Informal sector, Challenges, Effectiveness, Healthcare Financing DOI: 10.7176/JESD/11-21-03 Publication date: November 30 th 2020
Highlights
In developing countries, the governments are facing with the challenge of providing access to equitable healthcare for their citizens
To provide a synthesis of the existing knowledge on community-based health insurance schemes, this study relies on secondary sources which were collected from published works on journals, newspapers, published and unpublished articles of credible and reliable online sources of organizations deals with the community-based health insurance schemes, health care financing, and universal health coverage
Uncertainty related to the availability of medical supplies and limited working hours at the dispensary creates non-renewal membership I.D. card which affects effectiveness and sustainability of the scheme (Macha et al.; 2014). Another quality related problem in the schemes is maltreatment by health care providers/workers, that is unfair treatment between card user and cash payers. This is due to the fact that non-member patients immediately pay their medical costs in-cash, whereas members of the schemes use membership I.D. card only to get services from the providers
Summary
The governments are facing with the challenge of providing access to equitable healthcare for their citizens. Health care financing is one of the most challenging problems facing the world’s poorest populations, especially in developing countries. Most of the population in low and middle income countries is neither covered by social security nor have access to health insurance. The health financing system in developing countries are characterized by a high reliance on external assistance and out-of-pocket payments (SIAPS, 2016). Out-of-pocket payment is the major option to pay for medical care and in case of severe sickness, when specialized treatment at a higher level is required, many households face difficulties to cover the cost of inpatient care and treatment costs. It is difficult to find money for seeking health care even for common illnesses in certain periods of the year (Yared, 2009)
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