Community Health Insurance Scheme Research Articles

Funding primary health care service delivery in the West Nile sub-region, Uganda

The provision of primary health care services is a global concern and quality health service delivery is based on a number of factors, including motivated health workers, good-quality infrastructure, consistent supply of medicines and technologies, adequate funding, sound health plans, and evidence-based policies. This study investigated the funding of primary health care service delivery in three local government districts in Uganda’s West Nile sub-region, and identified deficiencies in the allocation, disbursement and timeliness of health funding which have a negative impact on service delivery. Inadequate funding affects the quality of services, limits essential supplies and causes excessive reliance on private financing, which is not sustainable in poor rural economies. In view of these findings, the study recommended deliberate action by both central government and district councils to increase the percentage of funding allocated in their annual budgets to the health sector, in line with the 2001 Abuja Declaration. The government of Uganda should consider prioritising an increase in total national budget allocations to local governments; primary health care disbursements from central government should be paid on time directly to health facilities by use of the ‘straight-through processing system’ for all types of funding; the government should introduce, support and encourage additional community financing initiatives such as Community Health Insurance Schemes; and district and local community leaders should be sensitised on the benefits of this approach.

Organisational Health and Resilience of Community Health Insurance Schemes in Bukavu Eastern DRC

Organisational Health and Resilience of Community Health Insurance Schemes in Bukavu Eastern DRC

FACTORS DETERMINING THE HEALTH SEEKING BEHAVIOUR OF RURAL DWELLERS IN DEKINA LOCAL GOVERNMENT AREA OF KOGI STATE, NIGERIA

In Dekina Local Government Area of Kogi State, the study looked at factors influencing how rural residents sought out health care. The study's specific goals included identifying the most prevalent diseases afflicting rural residents in Dekina L.G.A, investigating the general health-seeking behaviour of rural dwellers, studying the factors that influence this behaviour, and examining the obstacles that patients in this area face. The study's framework was based on rational choice theory. The study used a survey research design, and a sample of 399 people was chosen from the 142, 112 study participants using a cluster sampling strategy combined with systematic simple sampling. Multiple regression was used to assess the hypothesis formulated. The study's conclusions showed that typhoid fever and malaria were the most frequent illnesses experienced by rural residents. The majority of rural residents in Dekina L.G.A. sought healthcare from nearby facilities for symptoms diagnosis and treatment, but even while taking medications, they supplemented modern drugs with herbal remedies. Cost of drugs/medical services, location of healthcare facilities, level of education, and income were found to be the main determinants of rural residents' health seeking behaviour in the study area. The rural dwellers exercise and get checks at doctors to stay fit. It was recommended among others that rural dwellers should make use of treated mosquito nets, avoid drinking dirty waters and foods, the cost of medical services should be regulated through the establishment of State and Community Health Insurance Scheme. 
 Keywords: Health, Illness, Health Seeking Behaviour, Rural Dwellers, Determining Factors.

Impact of community-based health insurance on healthcare utilisation and out-of-pocket expenditures for the poor in Senegal

ObjectivesThis study aims to assess the impact of the subsidised community health insurance scheme in Senegal particularly on the poor.Design and settingThe study used data from a household survey conducted...

Determinants of Willingness to Pay for Community Health Insurance Among Commercial Motorcyclists in Kampala City, Uganda: A Contingency Valuation Study

Background: To assess determinants of Willingness to Pay (WTP) for Community Health Insurance (CHI) among commercial motorcyclists (Boda boda riders) in Kampala City, Uganda. Methods: This is a descriptive study with a cross-sectional design. A total of 381 commercial motorcyclists were selected from Nakawa Division using purposive and simple random sampling methods. Structured interviews and contingency valuation method were used for data collection and measuring WTP for CHI. Data were collected in April, May and June 2019. Data were analyzed in SPSS software, v. 21 by multivariate regression analysis and considering at significance level of P<0.05. Results: Most of Boda boda riders had WTP for CHI (70%); 7 out of 10 commercial motorcyclists were willing to pay a premium of at least 70,000 UGX (20 USD).Those with at least five years of experience in the commercial motorcycle business were 9 times more willing to pay for CHI. Those with hired motorcycles and a history of involvement in a riding accident were less likely to pay for CHI. The other key determinants of WTP included: Being a commercial motorcyclist for 3 years or more, being aware of CHI, self-employment (riding own motorcycle), a history of payment for any form of insurance, and being single. Conclusion: The WTP for CHI is high among commercial motorcyclists in Kampala City. The WTP among these motorcyclists is determined more by individual factors and less by insurance scheme-related factors. The results recommend the coverage of informal sector by CHI schemes to increase universal health coverage in Uganda.

Investigating the influence of community health insurance on health seeking behaviors and demand for maternal healthcare services in Nigeria

The rate of maternal mortality in Nigeria remains high despite recent worldwide success in reducing it. Data from the World Bank suggests that maternal mortality rate (MMR) is about 917 per 100,000 for Nigeria and this is only second to India globally. Hence, in this study, we investigate the research question of to what extent can community health insurance influence maternal health in Nigeria by looking at aspects of maternal health such as health seeking behaviors of, and demand for maternal healthcare services among women in Nigeria The data utilized for the study was sourced from the 2013 Nigeria Demographic and Health Survey (NDHS), while estimations were done using Propensity Score Matching and Nearest Neighbor Matching. The result from the estimations shows that the average treatment effect on the treated (ATT) reveals that participating in a Community Health Insurance (CHI) scheme improves the health seeking behavior of a woman by about 17% compared to when she does not participate. The result further reveals that those who participated in the scheme were likely to have 58% increased antenatal care visits compared to when they do not participate. This study concludes that CHI is protective of maternal health. It is likely to improve health seeking behavior of women in Nigeria by reducing out‐of‐pocket payment for health services. Further recommendations are also discussed.

Awareness and Willingness to Participate in Community Health Insurance Scheme Among Household Heads in Rivers State Nigeria

Background: Community-Based Health Insurance scheme (CBHI) can guarantee access to quality healthcare services and increase universal health coverage. Enrolments for this scheme in Nigeria is however low. This study sought to assess the awareness and willingness of households in Rivers State to participate in CBHI. Methodology: This is a cross-sectional descriptive study done in Rivers State, Nigeria. A total of 332 heads of households recruited through multistage sampling and gave written informed consent were interviewed using a pretested interviewer-administered questionnaire. Participants gave information on their socio-demography, awareness and willingness to participate in CBHI and reasons for unwilling to participate. Data were analyzed using IBM SPSS Statistics 22 and results were presented in frequency tables. Chi-square test was done at P< 0.05.

Healthcare Service Payment Methods and Coping Strategies of Nomads and Labor Migrants in Oyo State, Nigeria.

Nomads and labor migrants constitute a vulnerable group beset with high healthcare costs due to lack of health insurance coverage. Their inability to pay for health care constitutes a threat to their well-being and health risk to the host community as they have higher morbidity from diseases and serve as a reservoir of infective agents. This study investigated how nomads and labor migrants pay and cope with necessary healthcare costs. A cross-sectional study was carried out among 323 migrants in four local government areas of Oyo State, which were selected purposively. A pretested semi-structured questionnaire that sought information on respondents' sociodemographics, healthcare payment methods and coping strategies were employed. Data were analyzed using descriptive statistics and chi-square test to test the association between categorical variables at P ≤ 0.05. The mean age of the respondents was 34.4 ± 1.4 years and 53.2% were farmers. Of the 200 respondents who had used the formal healthcare system, 13 (6.5%) obtained free services via the National Health Insurance Scheme (NHIS) and 187 (93.2%) paid out of pocket for service. Coping with health bills, 115 (62.2%) paid from savings, 34 (18.4%) borrowed money, and 58 (31.4%) sold property. Those with formal education were more likely to pay through NHIS (χ2 = 9.7, P = 0.002). Nomads/migrants in this study have demonstrated the inability to cope with payment of health bills, suggesting the need to look into the policy on healthcare funding/support to migrants and educationally disadvantaged persons. The creation of prepaid pooled payment systems such as social and community health insurance schemes is suggested.

Care of the Sick Newborn in a Cottage Hospital Level in a Developing Country.

Introduction:Neonatal morbidity and mortality are high in Nigeria. The establishment of more centers that could offer adequate management of high-risk pregnancies and neonates is essential.Objectives:This study seeks to describe sick newborn care at the cottage hospital level in Southern Nigeria with the aim of drawing lessons that may be useful to similar environments.Subjects and Methods:A description of facility upgrading and staff training in perinatal care at a public-private partnership cottage hospital with a robust community health insurance scheme in Nigeria is made. A retrospective descriptive study of the morbidity and outcomes of admitted neonates in the facility between March 2016 and February 2017 was made.Results:Out of 3630 babies born in the facility (302 per month), 189 were admitted, yielding an admission rate of 52.1/1000 live births. The main morbidities were neonatal hypoglycemia (32.4%), preterm low-birth weight (24.9%), neonatal sepsis (22.8%), and neonatal jaundice (12.7%). Sixteen of the 109 neonates died giving a mortality rate of 8.5%. The main causes of deaths were birth asphyxia (7 or 43.8%), meconium aspiration (6 or 37.5%), and congenital malformation (3 or 18.8%).Conclusion and Recommendations:The neonatal admission and mortality rates are quite low in this cottage hospital and similar to the situation even in developed environments. This salutary scenario is probably due to good antenatal and perinatal care, and a robust community health insurance scheme which enhances services uptake and public–private partnership which engenders infrastructure expansion and maintenance. This model is recommended for the hospitals in our region.

Demand To Join The Community Health Insurance Scheme: A Predictive Analysis Of Individuals From Dodoma Municipality, Tanzania

This paper analysed factors that influence the demand to join community health insurance scheme. Using random sampling, data were collected from 130 households at Dodoma Municipality in Tanzania. Logistic regression model was used in testing the socio economic and demographic factors influencing decisions to join the health insurance scheme among the households. It was found that, age, increased levels of schooling and increased income levels of individuals influence the chances of joining CHIS. However, being a female individual and higher distance to health facility decrease the chances of joining the scheme . The analysis also suggests that the professional activity carried out, the marital status of the individuals, as well as the number of dependents in a household do not explain the decision to join Community Health Insurance Scheme . In view of the research findings, policy proposals are suggested including creating an enabling environment by putting in place a coherent legal and policy framework, financially supporting the very poor and vulnerable groups who are unable to pay premium to make the schemes more inclusive, increase in funding for health services and improvement in the quality of care, continued awareness creation of communities/ patients on the importance of joining health insurance schemes.

Impact of community-based health insurance on child health outcomes: Evidence on stunting from rural Uganda

While community-based health insurance (CBHI) becomes increasingly integrated into health systems in developing countries, there is still limited research and evidence on its probable health impacts beyond its functions for health financing or for facilitating access to services. Using a cross-sectional data from rural south-west Uganda, we apply a two-stage residual inclusion instrumental variables method to study the impact of community health insurance on stunting in children under five years. Results indicate that each year a household was enrolled in insurance was causally associated with a reduction in the probability of stunting of 5.7 percentage points. Predictive marginal effects show that children in households which have had insurance for at least 5 years had a probability of stunting of only 0.353 compared to 0.531 for children in households with no insurance. Households in CBHI were more likely to attend more free antenatal and postnatal care visits and report fewer illnesses and reported less health expenditures. Moreover, CBHI enrolment was also associated with reduced health costs. We recommend that developing countries should facilitate the expansion of community health insurance scheme not only for their contribution to health financing but even more for mortality and morbidity aversion.

Impact of Community-Based Health Insurance on Child Health Outcomes: Evidence on Stunting from Rural Uganda

While community-based health insurance (CBHI) becomes increasingly integrated into health systems in developing countries, there is still limited research and evidence on its probable health impacts beyond its functions for health financing or for facilitating access to services. Using a cross-sectional data from rural south-west Uganda, we apply a two-stage residual inclusion instrumental variables method to study the impact of community health insurance on stunting in children under five years. Results indicate that each year a household was enrolled in insurance was causally associated with a reduction in the probability of stunting of 5.7 percentage points. Predictive marginal effects show that children in households which have had insurance for at least 5 years had a probability of stunting of only 0.353 compared to 0.531 for children in households with no insurance. Households in CBHI were more likely to attend more free antenatal and postnatal care visits and report fewer illnesses and reported less health expenditures. Moreover, CBHI enrolment was also associated with reduced health costs. We recommend that developing countries should facilitate the expansion of community health insurance scheme not only for their contribution to health financing but even more for mortality and morbidity aversion.

Knowledge, Practice and Willingness to Participate in Community Health Insurance Scheme among Households in Nigerian Capital City

<p><strong>Background:</strong> Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals. The objective of the survey was to determine knowledge, practice and willingness of households in Nigerian Capital City to pay and participate in Community Health Insurance Scheme.</p><p><strong>Materials and Methods:</strong> This descriptive and analytical cross-sectional study was carried out using the multistage cluster sampling technique to obtain data from 300 selected household heads or main financial decision makers. The data was analyzed using EPI-INFO software package. Statistical significance of p < 0.05 and confidence limit of 95% was used.</p><p><strong>Results:</strong> The major findings showed that the level of awareness (13%) concerning Community Health Insurance (CHI) was found to be very low among the respondents. The general principles of CHI were also poorly understood by the respondents. Attitude to the programme was positive as many showed interest in participating and enrolling themselves (97.0%), some family members (96.3%) and entire family members (90.3%). Borrowing money to settle medical bills in this study has occurred in 30% of instances. Majority of respondents were willing to pay premiums ranging from N450 (96.6%) to N1200 (72.5%) for simple packages that do not include surgery and hospitalization.</p><p><strong>Conclusions:</strong> The community members were willing to participate and enrol if the programme is brought to them. There is a need to adequately subsidize the premiums that respondents were willing to pay in order to meet up with the cost of treatment.</p><strong>Key Words:</strong> Willingness, Participate, Community Health Insurance.

The Impact of National Health Insurance Program on Household Health Expenditures and Utilization of Health Services in Indonesia

Background: Indonesia has implemented social security program through Government-run health insurances through PT. ASKES for civil servants and pensioners, PT. JAMSOSTEK for private employees, provided Community Health Insurance scheme (JAMKESMAS) and Regional Health Insurance (JAMKESDA) for the poor. Since 2014 central government has implemented JKN (jaminan Kesehatan Nasional or National Health Insurance) scheme which basically merged all various government-run social security for health in a single Social Security Agency namely BPJS(Badan Penyelenggara Jaminan Sosial). This study examines the impact of JKN implementation on households health expenditure and health care utilization by comparing before and after the implementation of JKN in 2014 using IFLS (Indonesian Family Live Survey) 2007 and IFLS 2014 data. Method: This study was an analytical study based on quantitative data using two panel data from IFLS (Indonesian Family Life Survey) or IFLS-4 2007dan IFLS-5 2014, by using univariate, bivariate, multivariate regression method and fixed effects regression analysis. Result: Compared to situation in 2007, the implementation of National Health Insurance (JKN) in 2014 had impacted on improving utilization of health care facilities. On the other hand, social determinant factors such as increasing household income, education level of household heads, having family members aged 65 old and above, having children below five years old, increasing health needs in 2014, resulted in increasing household health expenditure in Indonesia. JKN also has no significant impact on reducing catastrophic health expenditure. Conclusion: Health insurance program in Indonesia had significant impacted on increasing utilization of health facilities, but had no significant impacted in reducing household health expenditure in Indonesia.

A quantitative study on factors influencing enrolment of dairy farmers in a community health insurance scheme.

BackgroundAccess to affordable and effective health care is a challenge in low- and middle- income countries. Out-of-pocket expenditure for health care is a major cause of impoverishment. One way to facilitate access and overcome catastrophic expenditure is through a health insurance mechanism, whereby risks are shared and financial inputs pooled by way of contributions. This study examined factors that influenced the enrolment status of dairy farmers in Western Kenya to a community health insurance (CHI) scheme.MethodsQuantitative, cross-sectional research was used to describe factors influencing the enrolment in the CHI scheme. Quota and convenience sampling was used, recruiting a sample of 135 farmers who supply milk to a dairy cooperation. Data were collected using a structured interview schedule and analysed using Stata SE, Data Analysis and Statistical Software, Version 12.ResultsFactors influencing non-enrolment were identified as affordability (40%; n = 47), unfamiliarity with the management of the scheme (37%; n = 44) and a lack of understanding about the scheme (41%; n = 48). An exploratory factor analysis was used to reduce the variables to two factors: information provision and understanding community health insurance (CHI). Logistic regression identified factors associated with enrolment in the Tanykina Community Healthcare Plan (TCHP). Supplies of less than six litres of milk per day (OR: 0.22; 95% CI: 0.06–0.84) and information provision (OR: 8.77; 95% CI: 2.25–34.16) were significantly associated with enrolment in the TCHP.Nearly 30% (29.6%; n = 40) of the respondents remarked that TCHP is expensive and 17% (n = 23) asked for more education on CHI and TCHP in an open-ended question.ConclusionRecommendations related to marketing strategies, financial approach, information provision and further research were outlined to be made to the management of the TCHP as well as to those involved in public health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1925-1) contains supplementary material, which is available to authorized users.

Who benefits from the Obio Community Health Insurance Scheme in Rivers State, Nigeria? A benefit incidence analysis.

A key aspect of monitoring and evaluating health programs is ensuring that benefits are reaching their target population. We conducted a benefit incidence analysis (BIA) of a Shell-sponsored community health insurance scheme in Nigeria to determine the extent to which the target group (the poor) was benefitting. We examined a sample of 616 patients' hospital attendance, financial and administrative records from 2012-2013. We estimated annual utilization rates and average unit costs for inpatient and outpatient services. We multiplied the two to produce a total cost per patient, then deducted annual out-of-pocket expenditures to estimate the total community-based health insurance scheme benefit per person. Benefits were multiplied by the total number of persons in each socioeconomic group to aggregate benefits. We used concentration curves and dominance tests to determine statistical significance at 5% and 10% levels of significance. Collectively, the poorest 20% of the population received 12% of benefits while the richest quintile received the largest share (23%). Inpatient and outpatient benefits are weakly regressive (pro-rich), statistically significant at a 10% level of significance. Although the poor were found to benefit, this BIA revealed a tendency towards pro-rich distributions. Removing co-payments for the poorest, reducing long wait and visit times and using community volunteers to help increase access to health services may improve benefits for the poor.

Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

BackgroundEquity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE), in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.MethodsWe used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.FindingsBetween 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.ConclusionDuring the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential to achieve equity of access to healthcare.

Use of major surgery in south India: A retrospective audit of hospital claim data from a large, community health insurance program

Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh. Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48. The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care.

Major surgery in south India: a retrospective audit of hospital claim data from a large community health insurance programme

BackgroundInformation about use of major surgery in India is scarce. This study aims to bridge this gap by auditing hospital claims from the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) that provides access to free tertiary care for major surgery through state-funded insurance to 68 million beneficiaries with limited household incomes—81% of population in states of Telangana and Andhra Pradesh (combined Human Development Index 0·485). Beneficiary households receive an annual coverage of INR 200 000 (US$3333) for admissions to any empanelled public or private hospital. MethodsPublicly available deidentified hospital claim data for all surgical procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. Findings677 332 surgical admissions (80% at private hospitals) were recorded at a mean annual rate of 259 per 100 000 beneficiaries (95% CI 235–283), excluding cataract and caesarean sections as these were not covered under the insurance programme. Men accounted for 56% of admissions. Injury was the most common cause for surgical admission (185 733; 27%) with surgical correction of long bone fractures being the most common procedure (144 997; 20%) identified in the audit. Diseases of digestive (110 922; 16%), genitourinary (82 505; 12%), and musculoskeletal system (70 053; 10%) were other leading causes for surgical admissions. Most hospital bed-days were used for injuries (584 days per 100 000 person years; 31%), digestive diseases (314 days; 17%), and musculoskeletal system (207 days; 11%), costing 19% (INR 4·4 billion), 13% (3·03 billion), and 11% (2·5 billion) of claims, respectively. Cardiovascular surgeries (53 023; 8%) alone accounted for 21% (INR 4·9 billion) of cost. Annual per capita cost of surgical claims was US$1·49 (95% CI 1·32–1·65). InterpretationOur findings are limited to a population socioeconomically representative of India and other countries with low-income and middle-income. Despite near universal access for major surgery, use continues to remain low, at levels expected in countries with per capita health expenditure below US$100, and lower than a tenth of rates estimated at spending (US$400–1000) comparable with financial access provided. Hence, strategies beyond traditional financing for care are required to improve use of surgery in LMICs. FundingThe George Institute for Global Health.

An Overview of Community Health Insurance and Emergency Health Management in a Rural Indian Tertiary Health Care Center

Providing universal health insurance to the 1.2 billion people of India is a daunting task, complicated by high poverty rates and a large unorganized labor sector. Health centers are concentrated in urban areas, despite the majority of the population being rural. Emergency medicine takes on added significance in view of inaccessibility of healthcare. Government and private partnerships in community health insurance schemes have played a significant role in making affordable healthcare accessible to rural communities and families below the poverty line. In this paper we have looked at the current situation in India, as well as the specific example of a community health insurance scheme provided by the Manipal group in coastal Karnataka to the rural fishing and agricultural community. Health indicators in this region are generally more positive than the rest of the country. Enrollment in this program has increased every year since its initiation. We then look at emergency medicine, which as a distinct field is still in its infancy in India. At present only 24 teaching hospitals across the country have post graduate programs in this field. Current emergency health management in most centers is cumbersome and involves significant delay in delivering care.