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Determinants of Rural Household’s Willingness to Participate in Community Based Health Insurance Scheme in Edo State, Nigeria
Abstract
The study examined rural households' willingness to participate in Community Based Health Insurance (CHBI) scheme in Edo State, Nigeria. Factors that are likely to influence household participation in the scheme were specifically determined. A random sample of 360 families from the three senatorial zones of the state was taken. Their responses were analyzed using frequency tables and logistic regression. The findings revealed that 59.4% expressed willingness to participate in a community based insurance scheme. Important reasons for those not willing to participate in the scheme were lack of trust on scheme fund administrators (mean = 2.54) and government policies/programmes which are considered very unstable and unsustainable (2.53). Based on the Logistics regression results, key demographic factors found to be significant determinants of rural households willingness to participate in the insurance scheme include household size (b= 0.507) and membership of town association or union (b=0.564), while income (b = -0.410), medical expenses incurred (0.316) and credit (0.277) were important economic characteristics. The study recommended the incorporation of community participation in the scheme especially in scheme management selection and awareness creation as measures to promote CBHI programme in the state.
... In this regard, different empirical studies were conducted based on contingent valuation method(CVM) to value households"(individual"s) willingness to pay for community health insurance schemes (Binam et al.,2007;Ataguba,2008;Onwujekwe et al.,2009;Oriakhi et al.,2012;Bukola &Usman,2013 andTundui &Macha,2014). However, they used a single bounded dichotomous choice (SBDC) and or another bidding game approach which are considered statistically less efficient to elicit information about households" actual WTP (Champ et al., 2009). ...
... However, unlike many empirical studies (Binam et al., 2007, Adane et al., 2014and Bukola & Usman, 2013, it found that level of education has insignificant impact on WTP. Oriakhi et al. (2012) conducted a study on determinants of rural households" willingness to participate in CBHI scheme in Nigeria (Edo State).The finding revealed that 56.4 %( out of 360 samples HHs) expressed their willingness to participate in the scheme. It also reported that household size and membership of the town association are key demographic factors, while income, medical expense incurred, credit opportunities were found important economic factors that significantly determine the rural households" willingness to participate. ...
... This may be due to the fact that rural households always link the probable financial burden they could face when their families seek medical treatment with the amount they are willing to pay for the scheme. This is inline with the study conducted in Fogera district, ANRS of Ethiopia, by Adane et al.(2014) and in Nigeria (Edo State) by Oriakhi et al.(2012). ...
The purpose of this study is to examine determinants of Rural Households’ Willingness to pay (WTP) for Community Based Health Insurance Scheme, in Kewiot and EfratanaGedem districts of Amhara region, Ethiopia. A cross-sectional design that followed a quantitative approach was used. Pre-tested structural and interviewer administered questionnaire was used to collect the desired data. A total of 392 sample rural households were taken by systematic random method. The contingent valuation method of double bounded dichotomous choice format (with calibration strategy) is applied to elicit households’ willingness to pay for the scheme. An interval regression model is used to estimate the mean willingness to pay and to explore the degree of association between predicted WTP and predictor variables. Households’ WTP for the scheme is found significantly associated with factor variables such as gender, education status, family size, level of awareness about the scheme, respondents’ trust in the scheme management, family ill health experience, households’ perceptions on health service quality, and their annual income level. The mean WTP amount is found 211ETB ($10.5) per annum per household. The result clearly shows that 79 % rural households are willing to pay for the scheme. Therefore, despite these factors affecting the rural households’ WTP, there is a potential demand for the community based health insurance scheme. We suggest that, among others, to improve the quality of health care and to build up community awareness and trust on the scheme management have paramount to enhance households’ WTP and hence, to expand health insurance coverage.
... While most studies have examined premium payment source for the CBHIS and factors that influence the WTP for the use of the scheme, the use especially by pregnant women living in the rural areas has received less attention [2,[4][5][6][7][8][9][10]. In Nigeria, the role of the CBHIS in accessibility to health care services for pregnant women is paramount due to high maternal and child mortality figures in the country. ...
... In terms of age groups, individuals between 30 and 39 years are argued to have more WTP for the use of the scheme than other age brackets [2]. Studies showed that males, persons with higher educational qualification and families with large household size, are more WTP for use of the scheme than females, individuals with no-formal education and smaller households [7][8]10]. Higher preference for the scheme is seen among rural dwellers and farmers especially those in self-employment [8,10]. ...
... Studies showed that males, persons with higher educational qualification and families with large household size, are more WTP for use of the scheme than females, individuals with no-formal education and smaller households [7][8]10]. Higher preference for the scheme is seen among rural dwellers and farmers especially those in self-employment [8,10]. ...
The Nigerian population has a predominantly rural populace and over 90% of the population do not have access to the National Health Insurance scheme due to the highly informal nature of the economy. The use of the Community Based Health Insurance Scheme (CBHIS) is vital to health status especially among pregnant women given that the Nigerian economy is the second largest contributor to global under-five and maternal deaths. This paper examined the Willingness to pay (WTP) for the use of the CBHIS and premium amounts WTP in rural parts of Lagos State. The study made use of the probit model to examine factors that affect the WTP and measures of central tendency to determine the premium charge that pregnant women are WTP for use of the scheme. Data was obtained from a cross section of 350 pregnant women in three different CBHIS centers in Lagos State Results of the study suggest that income, employment status, household size, marital status and distance to the CBHIS significantly determine the WTP for the use of the CBHIS. Use of the CBHIS would be relatively high when monthly premium is set at N 500. The average amounts that pregnant women are WTP for use of the scheme was about N1,186.40 (US $6.02) per month. Efforts meant to raise the use of the CBHIS in rural communities by pregnant women, should incorporate strategies that will reduce premium payment below existing rate and create enlightenment of benefits of the scheme particularly for women in self-employment.
... Meta-analysis was conducted for 18 [21][22][23]28,35,40,[44][45][49][50]52,61,63,65,[68][69][73][74] quantitative studies. We studied in depth the following variables: The results of the meta-analysis (pooled effect size and 95 percent confidence intervals) are summarized in Table 1 for enrolment and Table 2 for renewal/dropout. ...
... Three authors [23,61,68] measured education in terms of number of years in school, and considered it a continuous variable. The rest [10,21,22,35,44,45,49,50,65,73] treated it as a categorical variable. ...
... We estimate the summary effects -0.0040 for the Asian locations [22,23,45,63,65] and 0.0414 for the SSA locations [21,49,50,61,68]. The summary effect for all locations combined is estimated at 0.0328 with R-square value = 0.059 (Table 1) and SE = 0.0002. ...
Introduction:
This research article reports on factors influencing initial voluntary uptake of community-based health insurance (CBHI) schemes in low- and middle-income countries (LMIC), and renewal decisions.
Methods:
Following PRISMA protocol, we conducted a comprehensive search of academic and gray literature, including academic databases in social science, economics and medical sciences (e.g., Econlit, Global health, Medline, Proquest) and other electronic resources (e.g., Eldis and Google scholar). Search strategies were developed using the thesaurus or index terms (e.g., MeSH) specific to the databases, combined with free text terms related to CBHI or health insurance. Searches were conducted from May 2013 to November 2013 in English, French, German, and Spanish. From the initial search yield of 15,770 hits, 54 relevant studies were retained for analysis of factors influencing enrolment and renewal decisions. The quantitative synthesis (informed by meta-analysis) and the qualitative analysis (informed by thematic synthesis) were compared to gain insight for an overall synthesis of findings/statements.
Results:
Meta-analysis suggests that enrolments in CBHI were positively associated with household income, education and age of the household head (HHH), household size, female-headed household, married HHH and chronic illness episodes in the household. The thematic synthesis suggests the following factors as enablers for enrolment: (a) knowledge and understanding of insurance and CBHI, (b) quality of healthcare, (c) trust in scheme management. Factors found to be barriers to enrolment include: (a) inappropriate benefits package, (b) cultural beliefs, (c) affordability, (d) distance to healthcare facility, (e) lack of adequate legal and policy frameworks to support CBHI, and (f) stringent rules of some CBHI schemes. HHH education, household size and trust in the scheme management were positively associated with member renewal decisions. Other motivators were: (a) knowledge and understanding of insurance and CBHI, (b) healthcare quality, (c) trust in scheme management, and (d) receipt of an insurance payout the previous year. The barriers to renewal decisions were: (a) stringent rules of some CBHI schemes, (b) inadequate legal and policy frameworks to support CBHI and (c) inappropriate benefits package.
Conclusion and policy implications:
The demand-side factors positively affecting enrolment in CBHI include education, age, female household heads, and the socioeconomic status of households. Moreover, when individuals understand how their CBHI functions they are more likely to enroll and when people have a positive claims experience, they are more likely to renew. A higher prevalence of chronic conditions or the perception that healthcare is of good quality and nearby act as factors enhancing enrolment. The perception that services are distant or deficient leads to lower enrolments. The second insight is that trust in the scheme enables enrolment. Thirdly, clarity about the legal or policy framework acts as a factor influencing enrolments. This is significant, as it points to hitherto unpublished evidence that governments can effectively broaden their outreach to grassroots groups that are excluded from social protection by formulating supportive regulatory and policy provisions even if they cannot fund such schemes in full, by leveraging people's willingness to exercise voluntary and contributory enrolment in a community-based health insurance.
... [1,22,23] However, the mean age of respondents obtained from studies carried out in Igbobi and Edo was slightly higher. [24,25] The male predominance in this study (75%) is in consonance with artisan study in Osun state with 72.6%. [1] This could be attributed to the nature of the job majorly requiring heavy workforce and men are usually more predisposed to heavy jobs than their female counterparts by nature. ...
... Less than 10% (7.7%) of respondents in this study earned <N 10,000, which was the amount; about 50% of artisans were reported as earning in a similar study in Osun state and of which 20% earned in a study carried out in Edo state. [1,25] Thus, a higher proportion of artisans in this study earned more than those in Osun or Edo state. The differences observed in the income of artisans in the different states could be attributed to the higher economic standard of Lagos State as a commercial nerve center of the country; prices and cost of living would probably influence the income of those working within the state. ...
... This is in consonance with what was reported in previous studies from Edo and Lagos that expressed negative attitude toward the scheme and similar studies from developed countries supported these findings. [24,25,30] Furthermore, a study carried out to access the general opinion of Nigerians toward insurance services reported similar findings of negative expressions toward any insurance service. [31] However, a different opinion of the scheme was observed in other studies carried out among NHIS clients and public where a positive disposition was expressed toward the scheme. ...
Background: Health insurance (HI) can serve as a vital risk protection for families and small businesses and also increase access to priority health services. This study determined the knowledge, attitude of artisans toward HI as well as their health-seeking pattern and willingness to join the HI scheme. Methodology: This descriptive cross-sectional survey used a multistage sampling technique to recruit 260 participants, using self-designed, pretested, interviewer-administered questionnaire. Data were analyzed using Epi-info version 7.0. Chi-square test, Fisher′s exact test, and logistic regression were used for associations; the level of significance was set at 5%. Results: The respondents were predominantly male, i.e., 195 (75.0%), with a mean age of 32.36 + 6.20 years and mean income of N 29,000 + 5798.5 ($1 ~ N 161). Majority of the respondents, i.e., 226 (86.9%) were not aware of HI. The overall knowledge was poor (6.5%) and the main source of information was through radio/television (41.2%). Nearly, half of the respondents (33 out of 67) identified the concept of HI as a pool of contributors′ fund for only healthcare service. A high proportion of the respondents (27 out of 34) were aware of the benefits of HI, although majority, i.e., 27 (79.4%) identified access to medication as the benefit. The majority of the respondents, i.e., 228 (87.7%) expressed negative attitude toward the scheme; however, 76.5% were willing to join the HI scheme. Conclusion: The artisans had low awareness/poor knowledge of HI which translated to a negative attitude toward the scheme. There is need for an aggressive stakeholders′ enlightenment campaign for increasing coverage.
... Wealthier households and individuals (richest quintile or as defined by the study) were more willing and able to pay more for health insurance than the less wealthy as seen in studies carried out in Cameroon, Burkina Faso, India, Nigeria and Malaysia [23,25,[27][28][29][30][32][33][34][35]. However one study conducted in Nigeria reported differently in terms of wealth quintile and enrolment whereby those with high income were less likely to pay than those with lower income [36]. Findings from qualitative studies also show that wealth quintile was stated as a sociodemographic factor revolving around the uptake of the scheme, and as shown by quantitative studies, affordability is a key factor affecting enrolment. ...
... In addition, household size was another key factor that was found to affect uptake of CBHI schemes. Studies conducted in India and Nigeria found that larger households (six members and above) were willing to pay higher amounts than relatively smaller households [28,29,36]. This differs from what was reported in some other studies conducted in Burkina Faso and India [25,27,31]. ...
... The use of modern medicine is also an important factor for enrolling into CBHI since the scheme requires the regular use of modern means of treatment; hence those who use modern medicine have been found to be willing to pay more than those who use other means of treatment as revealed by studies conducted in Cameroon, Burkina Faso and Nigeria [22,23,32,36]. Trust in CBHI was also reported to affect willingness to pay in Nigeria and Cambodia, as household heads that have greater trust in the scheme were willing to pay higher amounts than their counterparts [29,40]. ...
Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs.
We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review.
Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment.
In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers' access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.
... Wealthier households and individuals (richest quintile or as defined by the study) were more willing and able to pay more for health insurance than the less wealthy as seen in studies carried out in Cameroon, Burkina Faso, India, Nigeria and Malaysia[23,25,2728293032333435. However one study conducted in Nigeria reported differently in terms of wealth quintile and enrolment whereby those with high income were less likely to pay than those with lower income[36]. Findings from qualitative studies also show that wealth quintile was stated as a sociodemographic factor revolving around the uptake of the scheme, and as shown by quantitative studies, affordability is a key factor affecting enrolment. ...
... In addition, household size was another key factor that was found to affect uptake of CBHI schemes. Studies conducted in India and Nigeria found that larger households (six members and above) were willing to pay higher amounts than relatively smaller households[28,29,36]. This differs from what was reported in some other studies conducted in Burkina Faso and India[25,27,31]. ...
... Health status also determined enrolment as seen in India, Cameroon and Nigeria[27,35,39]as individuals with better health status were willing to pay less amounts for health insurance compared with individuals with poorer health status[23]. The use of modern medicine is also an important factor for enrolling into CBHI since the scheme requires the regular use of modern means of treatment; hence those who use modern medicine have been found to be willing to pay more than those who use other means of treatment as revealed by studies conducted in Cameroon, Burkina Faso and Nigeria[22,23,32,36]. Trust in CBHI was also reported to affect willingness to pay in Nigeria and Cambodia, as household heads that have greater trust in the scheme were willing to pay higher amounts than their counterparts[29,40]. ...
Objective: Most low-income and middle-income countries (LMICs) have been unable to achieve the key objective of universal coverage known as ‘universal financial protection’. A promising avenue to provide health insurance for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs.
Methodology: We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status or language of publication. We included both quantitative and qualitative studies in the review.
Results: Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting time), was found to directly implicate on low coverage. Trust in both the scheme and caregivers were also found to affect enrolment. Educational attainment (whereby the less educated are willing to pay less than the highly educated), sex (whereby men are willing to pay more than women), age (whereby young individuals are willing to pay more than older individuals) and household size (whereby larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment.
Conclusion: Lack of funds, poor quality of care, and lack of trust are major reasons for the low CBHI coverage in LMICs; and need to be considered when such schemes are set up to ensure financial protection is achieved.
... 15,35 This research showed that more of the respondents (70.3%) had the desire to enroll under NHIS while only 29.3% did not have the desire to enroll under the Insurance Scheme, though it was not statistically significant ( Figure 3). This is in keeping with a study done by Olugbenga-Bello et al which showed that most of the respondents were willing to participate in NHIS and also a study done by Oriakhi and Onemolease, 2012 which showed that almost 60% of the respondents indicated willingness to participate in Community-based Health Insurance (CBHI), 21.7% were not and 18.9% were unsure. 15,36 Most of the respondents (35.3%) who desired to enroll under NHIS wanted to because of Subsidizing health care cost followed by Improvement in quality of health care, Enhancing health seeking behaviour and only 7.1% of the respondents desired to enroll under NHIS because it would give them a feeling of privilege and class ( Figure 4). ...
... This is in keeping with a study done by Olugbenga-Bello et al which showed that most of the respondents were willing to participate in NHIS and also a study done by Oriakhi and Onemolease, 2012 which showed that almost 60% of the respondents indicated willingness to participate in Community-based Health Insurance (CBHI), 21.7% were not and 18.9% were unsure. 15,36 Most of the respondents (35.3%) who desired to enroll under NHIS wanted to because of Subsidizing health care cost followed by Improvement in quality of health care, Enhancing health seeking behaviour and only 7.1% of the respondents desired to enroll under NHIS because it would give them a feeling of privilege and class ( Figure 4). ...
Background: Health seeking behaviour includes all those behaviour associated with establishing and retaining a healthy state, plus aspects of dealing with the departure from that state, which can generally be improved by health care financing and insurance. The objective of the study was to evaluate the knowledge, attitude and practice of National Health Insurance Scheme (NHIS) of the people of Unguwar soya community and its relationship to their health seeking behaviour.Methods: The study one was a cross sectional community based descriptive study carried out using a multi stage sampling process in Unguwar soya community, Plateau state, Nigeria. An interviewer administered structured questionnaire was utilized and administered to 252 eligible respondents for a period of 3 months (September-November, 2019).Results: Majority of the respondents were aged 20-29 years (33.7%), females (63.5%), with majority earning above 30,000 naira (25.8%). Most respondents (59.5%) had heard about NHIIS. Most (70.7%) had good attitude towards NHIS and had the desire to enroll under NHIS (70.3%), mostly because of Subsidization of health care cost. Only 13.3% of the respondents are registered with NHIS. The most of the population visit chemist shops when ill (31.2%), however, majority of NHIS enrollees go to hospitals to seek care. None of those enrolled go to health centers, pharmacies, and home of health workers. 90.1% agreed that their health seeking behaviour will improve if enrolled under NHIS.Conclusions: Index population has inadequate awareness and low practice of the NHIS also with long run impact on the health seeking behaviour of residents of Unguwar soya community.
... Reasons 17 times more likely to use CBHI than the housewives. This finding is similar to Edo state of Nigeria (Oriakhi et al., 2012). This may be due to scheme's interval of payment which is once in a year. ...
... Trustworthiness of the CBHI officials had negative association with CBHI utilization. This evidence was supported by the study conducted in Edo state of Nigeria, where the respondents deterred form participation in government program were attributed to lack of trust in officials managing the program (Oriakhi et al., 2012). ...
Background: Health insurance reduces impoverishment, inequitable access, and utilization of healthcare attributed to out of pocket healthcare expenditure. However, the available evidence on the magnitude and the factors associated with the utilization by households is rare, which makes it difficult to take remedial action for its sustainability and effectiveness. Therefore, the aim of this study was to assess community based health insurance utilization and the associated factors among informal workers in Gida Ayana district, east Wollega Zone, west Ethiopia. Methods: A community based cross-sectional study was conducted on 644 households in February 2018. Multistage sampling technique was used to select households. Data were collected using pretested and structured questioner and analyzed using SPSS Version 22. Bivariate and multivariable logistic regressions were computed to identify the factors associated with community based health insurance utilization. A p-value of < 0.05 with 95% confidence interval was used to declare the level of statistical significance. Results: The magnitude of community based health insurance utilization was 27.5% (95% CI: 23.8, 31.2). Older ages (41-50) (AOR=3.26; 95% CI:1.80, 5.90), having formal education (AOR=5.8; 95% CI: 3.38, 10.00), being farmer (AOR= 2.9; 95% CI:1.40, 6.00), households with better wealth status (AOR=2.40; 95% CI:1.40, 4.26), disagreement on affordability of premium (AOR=0.50; 95% CI:0.27,0.97), good knowledge (AOR=2.30; 95% CI:1.40, 3.85), self-assessed health status as poor (AOR=4.2; 95% CI:2.20, 8.00) and being neutral on trustworthiness of officials (AOR=0.43; 95% CI:0.20, 0.76) had statistically significant association with community based health insurance utilization. Conclusion: The magnitude of community based health insurance utilization in this study was low. Older ages, having formal education, better wealth status, being farmer, having good knowledge about community based health insurance utilization, self-assessed health status as poor and being neutral on trustworthiness of officials were significantly associated with community based health insurance utilization. The district's health office should disseminate information , deeply discuss the working principles and reduce premiums payments of community based health insurance to enhance the utilization.
... Factors influencing informal sectors' WTP for Nigerian social health insurance scheme are similarly sparse, but some inference can be drawn from the general Nigerian population. Age, [17] gender [17,21] education [10,17] income [17,18,22] and family size [17,18] have all been shown to positively influenced WTP in the country. Marital status, [16,17] adequate awareness and good perception are also very good influencers of participation in the scheme [11,23] Having chronic illness showed contrasting evidence. ...
... While some studies outside Nigeria reported that people with chronic illness have a high likelihood to participate in a health insurance scheme, [24][25][26] other studies from Nigeria showed less likelihood to participate amongst people with chronic illness. [23] Frequent spending on health-care services was evident as a potent predictor of WTP for health insurance scheme; [19,21] likewise, the experience of catastrophic health expenditure motivates people to participate in health insurance scheme [22] These determinants and pattern of WTP are of essence for the insurance administrator to understand. They influence the success or otherwise of the scheme. ...
In recent times, many states of the federation have attempted to implement a social health insurance scheme. This is with a view to achieving universal health coverage in their states. One of the main target populations of the scheme is the informal sector workers. There are still concerns about whether enough pieces of evidence were used to establish the scheme across the country. This perspective article briefly highlights some evidence to support the informal sectors willingness to participate and pay for a statewide health insurance scheme in Nigeria.
... [21][22][23][24][25][26] However, on the contrary, a Nigerian study showed that lower income households were more likely to join and pay for the scheme compared to wealthier households. [27] Regarding household size, larger households(six and above) were more willing to join and pay for the scheme compared to smaller households. [20,24,25] On the contrary, other studies showed that larger households were less willing to join the scheme. ...
... [20] Use of modern medicine for healthcare has been documented as a determinant of willingness to pay for CBHIS. [21,[27][28] However, to the best of our knowledge, no study has examined whether use of traditional medicine [which is a common practice in Nigeria] affects WTJ the scheme. Also, how the above sociodemographic factors affect WTJ the scheme in the study area remains unknown. ...
... The mean amount of money WTP in the study is greater than study in Nigeria [17] and Ethiopia [9]. However, this was lower than study done in Cameroon [18], Nigeria [19], Namibia [20], Bangladesh [21] and Burkina Faso [22]. The discrepancy might be due to the difference in study period, area, design and participants. ...
... The wealth status of the families had positive and significant association with WTP. Which is similar with other studies conducted inEthiopia [12], Nigeria [19], Bangladesh [21], China [29], St. Vincent [30], and India [24]. The possible explanation might be having more wealth is associated with high asset losses if an unexpected event occurs that leads to be households more WTP for the insurance than the poorer. ...
Objective
Community based health insurance schemes are becoming recognized as powerful method to achieve universal health coverage and reducing the financial catastrophic shock of the community. Therefore, this study aimed to assess willingness to pay for community-based health insurance and associated factors among rural households of Bugna District, Ethiopia.
Results
A total of 532 study participants were included in the study. The finding indicated that 77.8% of the households were willing to pay for the community-based health insurance. The average amount of money the households were willing to pay per household per annum was 233 ETB ($11.12 USD). The result of the study also revealed that attending formal education[ß = 3.20; 95% CI = 1.87, 4.53], history of illness [ß = 2.52; 95% CI = 1.29, 3.75], household size [ß = 0.408; 95% CI = 0.092, 0.724], awareness about the scheme [ß = 2.96; 95% CI = 1.61, 4.30], and wealth status [ß = 5.55; 95% CI = 4.19, 6.90] were factors significantly associated with willingness to pay. Therefore, enhancing awareness of the community about the scheme, considering the amount of premium as per household family size and wealth status might increase household’s willingness to pay for community-based health insurance.
Electronic supplementary material
The online version of this article (10.1186/s13104-019-4091-9) contains supplementary material, which is available to authorized users.
... 32 That wealthier households are more willing to join or pay for CBHI is expected and not surprising. However, studies in Nigeria 35,36 showed that the rich in rural areas were significantly less willing to pay for CBHI than the poor. A crosssectional survey in the south-south region of Nigeria showed that respondents with lower income were 1.4 times more willing to join a CBHI program than those with higher income. ...
... A crosssectional survey in the south-south region of Nigeria showed that respondents with lower income were 1.4 times more willing to join a CBHI program than those with higher income. 36 Another study in southwest Nigeria showed that income was negatively associated with willingness to pay for CBHI in rural areas while it was positively associated in urban areas where more services were available and costs were higher. A unit increase in income quintile decreased willingness to pay by 53% in rural areas while it increased it by 77% in urban areas. ...
Background
Out-of-pocket payments for health care services lead to decreased use of health services and catastrophic health expenditures. To reduce out-of-pocket payments and improve access to health care services, some countries have introduced community-based health insurance (CBHI) schemes, especially for those in rural communities or who work in the informal sector. However, there has been little focus on equity in access to health care services in CBHI schemes.
Methods
We searched PubMed, Web of Science, African Journals OnLine, and Africa-Wide Information for studies published in English between 2000 and August 2014 that examined the effect of socioeconomic status on willingness to join and pay for CBHI, actual enrollment, use of health care services, and drop-out from CBHI. Our search yielded 755 articles. After excluding duplicates and articles that did not meet our inclusion criteria (conducted in low- and middle-income countries and involved analysis based on socioeconomic status), 49 articles remained that were included in this review. Data were extracted by one author, and the second author reviewed the extracted data. Disagreements were mutually resolved between the 2 authors. The findings of the studies were analyzed to identify their similarities and differences and to identify any methodological differences that could account for contradictory findings.
Results
Generally, the rich were more willing to pay for CBHI than the poor and actual enrollment in CBHI was directly associated with socioeconomic status. Enrollment in CBHI was price-elastic—as premiums decreased, enrollment increased. There were mixed results on the effect of socioeconomic status on use of health care services among those enrolled in CBHI. We found a high drop-out rate from CBHI schemes that was not related to socioeconomic status, although the most common reason for dropping out of CBHI was lack of money to pay the premium.
Conclusion
The effectiveness of CBHI schemes in achieving universal health coverage in low- and middle-income countries is questionable. A flexible payment plan where the poor can pay in installments, subsidized premiums for the poor, and removal of co-pays are measures that can increase enrollment and use of CBHI by the poor.
... 21 In our study, household members' age was a significant factor for members' compliance with the CBHI scheme, older members were less likely to comply with CBHI scheme requirements when compared with those members aged less than 20 years, this finding is similar to the studies conducted in rural areas in Senegal, Edo state of Nigeria and Bahir and Uttar Pradesh in India. [20][21][22] However, different studies indicated that age does not seem to have any impact, previously there have been no age categories. 23 This could be due to older people being excluded from the community economically and socially more often, and as a result, they find it more challenging to take part in CBHI schemes. ...
... Moreover, CBHI members who had positive attitudes toward CBHI management, were more likely to comply with CBHI requirements, which is similar to the study conducted in the Edo state of Nigeria, and the possible reason for this could be members' trust in the scheme benefits, the management, and health facilities which are providing health services to the members. 20 The validity of the study may be inadequate due to its cross-sectional instead of longitudinal study design. Though this is the first study of its kind in the study area, we believe it creates cognizance in Ethiopia and provides useful information for the existing health care service. ...
Background: Community-based health insurance (CBHI) is becoming a prominent and promising concept in tackling financial health care issues confronting the poor rural communities in developing countries. Ethiopia endorsed and constituted CBHI schemes in 13 pilot “woredas” in 2010/11. This study aimed to assess the compliance of the community to CBHI scheme requirements in Thehuledere district, northeast Ethiopia.
Methods: A community-based cross-sectional study was conducted among 530 respondents between April and June 2015 in Thehuledere District, South Wollo Zone, northeast Ethiopia. A systematic random sampling technique was deployed to select the study participants. A self-administered, structured, pre-tested questionnaire was used to collect the data. Bivariate and multivariate logistic regression analyses were used to identify factors associated with CBHI compliance.
Results: A total of 511 study participants were included in the study. Approximately 77.9% of the study population complied with CBHI requirements: members’ age (AOR = 0.74, 95% CI: 0.62–0.8), premium fee affordability (AOR: 2.66, 95% CI: [1.13–4.42]), members’ occupation (AOR = 0.14, 95% CI: 0.04–0.45), members’ attitude toward CBHI management (AOR = 2.11 [1.14–3.90]), and CBHI members’ knowledge (AOR = 0.24, 95% CI: [0.13–0.42]) were found to be major predictors of community compliance to CBHI requirements.
Conclusion: CBHI requirement compliance at the early stage was relatively high. We observed that members’ age, premium fee affordability, occupation, attitude, and knowledge were significant predictors. CBHI management’s involvement in awareness creation and training on requirements of the CBHI scheme would contribute to better outcomes and success.
Keywords: compliance, community-based health insurance, Ethiopia
... [10][11][12] Existing evidence also shows that membership in both formal and informal savings and credit schemes is an important predictor of participation in health insurance programs. [13,14] A study in Edo State, Nigeria revealed that 59.4% of rural households indicated willingness to participate (WTP) in Community-Based Health Insurance, [15] while another from Osun State, Nigeria showed that 82.4% of artisans were willing to participate in the same scheme. [16] According to the World Health Organization (WHO), an efficient National Health Insurance model is key to achieving universal health coverage that would ensure everyone has access to good-quality health services as they need without becoming impoverished as a result. ...
... [2,3] The WTP in the NHIS indicated by 73.2% of those aware of the Scheme in this group was rather high, and consistent with 59.4% and 82.4% found in rural households of Edo State and among artisans in Ilorin, respectively. [15,16] However, the rural households in Edo were educated on the concept of NHIS just before data collection, while WTP among the artisans was assessed in all the participants irrespective of their awareness status. These findings underscore the critical role of awareness in the promotion of participation in the NHIS. ...
... 2, Issue 4, 2014 ~ 61 ~ for an insurance cover than respondents in lower income categories. This result is consistent with findings by Dror et al. (2007), Oriakhi and Onemolease (2012) and Bonan, Lemay-Boucher, and Tenikue (2013) who found a positive relationship between income levels and respondents' willingness to pay for a health insurance. However, Dror et al. (2007) also found that the relationship between WTP and household income is less than linear. ...
... This finding also agrees fairly well with finding by Binam, Nkama, and Nkendah (2004) and Bärnighausen, Liu, Zhang, and Sauerborn (2007) who reported a non-significant impact of education on the WTP for community based health Insurance in Cameroon and China respectively. On the other hand, our finding contradicts those of Dror et al. (2007) and; Oriakhi and Onemolease (2012) who found a significant relationship between education of the household head and WTP. ...
This study examines the effect of social capital on willingness to pay (WTP) for health services provided through community based health insurance schemes (Community Health Fund) in Tanzania. The study covered 274 household heads. We use probit regression analysis to model the relationship between the predictors and our outcome variable. Our results have shown that with the exception of religion, all other social capital variables have a positive and significant impact on the WTP for the Community Health Fund (CHF). Specifically, membership in social organisations and networks, trust among community members and trust of community members on scheme management are positively and significantly related to WTP. On the other hand, the age, education level, household size and number of children and participation in health insurance are not predicting WTP for CHF. Taken together, these results suggest that enhancing access to health care services in the rural areas and the sustainability of CHF would require building appropriate forms of social capital at individual and community levels. Specifically, CHF may increase enrolment through the existing social organisations and associations. Similarly, CHFs may well increase their membership if the avenues for trust building are created and nurtured. JEL Classifications: I1, I3
... But, this initial figure is greater than findings from Edo state of Nigeria (60%) [22]. The discrepancy may be attributed to the scenario employed in this study which was not used in the previous study. ...
... The number of total family size, housewives (in comparison to farmers), participation in iddirs, amount contributed to iddirs monthly, individual social capital and community level horizontal trust had positive associations with the probability of WTJ the CBHIS. These findings are similar with those found in South Africa [24], Lao PDR [25], Nigeria [22] and rural areas of China [26,27]. ...
Background:
Even though Ethiopia bears high burden of diseases, utilization of modern health care services is limited. One of the reasons for low utilization of healthcare services is the user-fee charges. Moving away from out-of-pocket charges for healthcare at the time of use is an important step towards averting the financial hardship associated with paying for health service. Prepaid plans for health are not accustomed in Ethiopia. Therefore, social and community based health insurance schemes were introduced since 2010.In this study, willingness of rural households in Debub Bench District, to join community based health insurance was assessed.
Method:
Cross-sectional community based study was conducted in Debub Bench District in March 2013 using a pretested structured questionnaire. Two stage sampling technique was used to select 845 households as study units which were allocated to the kebeles proportionately. The sampled households were selected using simple random sampling technique. Data were entered into EPIDATA 3.0 and analyzed with SPSS version 20.
Result:
Among 845 sampled households, 808 were interviewed (95.6% response rate). About 78% of the respondents were willing to join the scheme. Most of demographic, socioeconomic variables and social capital were found to be significantly associated with willingness to join community based health insurance.
Conclusion:
If the scheme is initiated in the district, majority of the households will enroll in the community based health insurance. Farmers, the married households, Bench ethnic groups and illiterate, the dominant segments of the population, are more likely to enroll the schemes. Therefore initiation of the scheme is beneficial in the district.
... Positive perception and understanding the CBHI benefit packages facilitate utilization of the scheme. In this [24]. Even though, no particular illness specified in this study respondents who had history of familiar illness in the last six months were more likely to be CBHI member. ...
... Positive perception and understanding the CBHI benefit packages facilitate utilization of the scheme. In this [24]. Even though, no particular illness specified in this study respondents who had history of familiar illness in the last six months were more likely to be CBHI member. ...
Introduction:
The health insurance system has been proven to offer effective and efficient health care for the community, particularly community-based health insurance is expected to ensure health care access for people with low economic status and vulnerable groups. Despite the significance of evidence-based systems and implementation, there is a limited report about the magnitude of CBHI utilization. Therefore, this study was done to assess factors associated with community-based health insurance utilization in Basona Worena District, North Shewa Zone, Ethiopia.
Method:
A community-based cross-sectional study was employed. We have included 530 households from 6 randomly selected kebeles. The data was entered using Epi-Data V 3.1 and exported to SPSS version 20.0 for statistical analysis. Bi-variable and multivariable logistic regression analyses were computed to determine factors associated with community-based health insurance utilization.
Result:
The study finding shows that 58.6% of the respondents were members of community-based health insurance. Respondents who had primary and secondary education levels were 2 times more likely to be members than those who had no formal education. As compared to those who had awareness, respondents who had no awareness about CBHI were 0.27 times less likely to be insured. Respondents who did not experience illness were 0.27 times less likely to be members than respondents who experienced illness.
Conclusion:
Educational status, awareness about CBHI, perception of CBHI scheme and illness experience of family influence CBHI utilization. There is a need to strengthen awareness creation to improve the CBHI utilization.
... This study showed that those with a non-formal occupation had a higher WTP for the cost-sharing scheme compared to those with a formal occupation. This, however, contradicts the results of research conducted in Northeast India [73] and the Edo State of Nigeria [74]. This is because those with a formal occupation do not have to make a direct payment for the insurance premiums, because the premiums are directly deducted from their salary with a subsidy from the companies in which they work. ...
Background:
National Health Insurance (NHI) in Indonesia requires an appropriate cost-sharing policy, particularly for diseases that require the largest financing. This study examined factors that influence willingness to pay (WTP) for cost-sharing under the universal health coverage scheme among patients with catastrophic illnesses in Yogyakarta, Indonesia.
Methods:
This was a cross-sectional study using structured questionnaires through direct interviews. The factors related to the WTP for cost-sharing under the NHI scheme in Indonesia were identified by a bivariable logistic regression analysis.
Results:
Two out of every five (41.2%) participants had willingness to pay for cost-sharing. Sex [AOR = 0.69 (0.51, 0.92)], education [AOR = 1.54 (0.67, 3.55)], family size [AOR = 1.71 (1.07, 2.73)], occupation [AOR = 1.35 (0.88, 2.07)], individual income [AOR = 1.50 (0.87, 2.61)], household income [AOR = 1.47 (0.90, 2.39)], place of treatment [AOR = 2.54 (1.44, 4.45)], a health insurance plan [AOR = 1.22 (0.87, 1.71)], and whether someone receives an inpatient or outpatient service [AOR = 0.23 (0.10, 0.51)] were found to affect the WTP for a cost-sharing scheme with p < 0.05.
Conclusion:
Healthcare (place of treatment, health insurance plan, and whether someone receives an inpatient or outpatient service) and individual socioeconomic (sex, educational, family size, occupational, income) factors were significantly related to the WTP for cost-sharing.
... To encourage fairness in fnancial contributions, the Ethiopian government implemented the community-based health insurance (CBHI) program in 2011 as an emerging and promising concept, which addresses healthcare challenges faced in particular by the poor individuals [29]. In the CBHI program, members regularly pay small premiums into a collective fund which is then used to pay for health services that they require [30]. ...
Background. An effective designation of health facilities improves the facility’s ability to respond to patients’ legitimate expectations. Limited evidence exists regarding the association between health system responsiveness and financial fairness in Sub-Saharan Africa, particularly in Ethiopia. The purpose of the study was, therefore to evaluate the health system responsiveness among insured and uninsured outpatients in primary healthcare facilities and determine the association between health insurance and health system responsiveness among outpatients. Methods. A facility-based cross-sectional study was conducted between March 30 and April 30,2021. The study sampled 423 participants using a systematic random sampling technique, and the data was collected with structured and pretested questionnaires administered by interviewers. Responsiveness was measured using the short version of the World Health Organization’s multicountry responsiveness survey, which has seven dimensions including autonomy, communication, confidentiality, attention, dignity, choice, and amenities. Using quantile regression, a specific association between health insurance and the health system responsiveness index was examined, adjusting for sociodemographic, quality, and satisfaction-related factors. Results. Of a total of 417 outpatients, 70.74% had health insurance. There was no statistical difference in health system responsiveness among insured and uninsured outpatients. Possession of health insurance was not associated with responsiveness (−0.67; 95%CI: −1.59, 0.25). There was a statistically significant negative relationship between age and responsiveness (−1.33; 95% CI: −2.47, −0.19) among 30–39 year olds and (−1.66; 95% CI: −3.02, −0.32) among 40–49 year olds. However, there was a positive statistical association between responsiveness with urban residence (+1.33; 95%CI: 0.37, 2.29), perceived quality of healthcare (+2.96; 95%CI: 1.95, 4.05), and patient satisfaction (3; 95%CI: 1.94, 4.07). Conclusions. There was no difference in the responsiveness of the health system between insured and uninsured outpatients. All domains need further improvement, particularly those more closely related to patients’ concerns, such as waiting time to get service and choices of healthcare providers. Furthermore, health facility administrators and the government should enhance responsive healthcare services in parallel with quality improvement and patient satisfaction, based on feedback from service users for better performance.
... Despite the plan of universal financial protection, there is variation in households' enrollment rate in the CBHI scheme from country to country. The willingness to participate in the CBHI scheme was 86.7% in Bangladesh [14], 69.6% in Saudi Arabia [15], 59.4% in Nigeria [16], and 46% in Cameron [17]. In Ethiopia, since the CBHI program was launched in the health financing reforms, a significant number of households were enrolled in the CBHI scheme, with variation in enrolment rate from region to region [10,18]. ...
Background:
Community-based health insurance (CBHI) scheme is an emerging strategy to achieve universal health coverage and protect communities in developing countries from catastrophic financial expenditure at the service delivery point. However, high membership discontinuation from the CBHI scheme remained the challenge to progress toward universal financial protection in resource-constrained countries. Therefore, this study assessed the community-based health insurance membership renewal rate and associated factors in the Gedeo zone, Southern Ethiopia.
Methods:
We conducted a community-based cross-sectional study among households in the Yirga Chafe district, Gedeo zone, Southern Ethiopia, from September 10 to 30, 2021. We used a multistage simple random sampling to recruit 537 respondents. We entered data into Epi-Info 7 and exported it to SPSS version 25 for analysis. We used a logistic regression model to determine factors associated with the CBHI scheme membership renewal. Variables with a P value of <0.05 and a 95% confidence level were considered to be significantly associated with the outcome variable.
Results:
We found the respondents' CBHI membership renewal rate was 82.68%. Those who enrolled in the CBHI scheme >3years (AOR = 3.12; 95% CI: 1.40-6.97), having illnesses in the last three months (AOR = 2.97; 95% CI: 1.47-5.99), the CBHI premium affordability (AOR = 12.64; 95% CI: 3.25-49.38), good knowledge of the CBHI scheme (AOR = 21.11; 95% CI: 10.63-41.93), perceived quality of health service (AOR = 4.21; 95% CI: 1.52-11.68), and favorable attitude towards the CBHI scheme (AOR = 3.89, 95% CI: 1.67-9.04) were significantly associated with the CBHI program membership renewal rate.
Conclusion:
In our study, we found the magnitude of CBHI members who discontinued their CBHI scheme membership was high. Besides, we found that the affordability of the CBHI premium, respondents' attitude, and knowledge of the CBHI program were predictor factors for dropout from the CBHI membership. Therefore, the government should consider the economic status of communities during setting the CBHI program contribution. Moreover, awareness creation through health education should be provided to improve participants' knowledge and perception of the CBHI program.
... Finally, the trustworthiness of the CBHI scheme by individuals was reported to be a facilitator of insurance enrolment, which was supported by two systematic reviews and meta-analyses and another study conducted in LMICs [10,21] and a primary study conducted in Nigeria [79]. As a result, stakeholders at various levels of government must collaborate to build a responsible and transparent governance system that promotes the scheme's trustworthiness to boost enrolment rates. ...
Background
Community-based health insurance (CBHI) is a risk-pooling approach that tries to disperse health expenditures across families with varying health profiles to provide greater access to healthcare services by allowing cross-subsidies from wealthy to poor populations. It is crucial to assess the level of CBHI enrolment and its determinants in Ethiopia, where government health spending is limited to less than 5% of GDP, far below the Alma Ata Declaration’s benchmark of 15%. Although various epidemiological studies on CBHI enrolment status and its determinants have been undertaken in Ethiopia, the results have been inconsistent, with significant variability. However, no nationwide study assessing the pooled estimates exists today. Furthermore, the estimated strength of association at the country level varied and was inconsistent across studies. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of CBHI enrolment and its determinants in Ethiopia.
Methods
A comprehensive search of studies was done by using PubMed, EMBASE, Science Direct, HINARI, Scopus, Web of Science, and the Cochrane Library. The database search was complemented by google scholar and some repositories for grey literature. The search was carried out from February 11 to March 12, 2022. The relevant data were extracted using a Microsoft Excel 2013 spreadsheet and analyzed using STATA TM Version 16. Studies reporting the level and determinants of CBHI enrolment in Ethiopia were considered. A weighted DerSimonian Laired random effect model was applied to estimate the pooled national prevalence of CBHI enrolment. The Cochrane Q test statistics and I ² tests were used to assess the heterogeneity of the included studies. A funnel plot, Begg’s and Egger’s tests, were used to check for the presence of publication bias.
Results
Fifteen studies were eligible for this systematic review and meta-analysis with a total of 8418 study participants. The overall pooled prevalence of CBHI enrolment in Ethiopia was 45.5% (95% CI: 32.19, 58.50). Affordability of premium for the scheme[OR = 2.58, 95% CI 1.68, 3.47], knowledge of respondents on the CBHI scheme[OR = 4.35, 95% CI 2.69, 6.01], perceived quality of service[OR = 3.21, 95% CI 2.04, 4.38], trust in the scheme[OR = 2.32, 95% CI 1.57, 3.07], and the presence of a person with a chronic disease in the household [OR = 3.58, 95% CI 2.37, 4.78] were all found to influence CBHI enrolment.
Conclusion
Community health workers (CHWs) need to make a high effort to improve knowledge of CBHI in rural communities by providing health education. To deal with the issue of affordability, due emphasis should be placed on building local solidarity groups and strengthening local initiatives to aid poor members. Stakeholders in the health service delivery points need to focus on the dimensions of high service quality. The financial gap created by the adverse selection of households with chronically ill members should be rectified by implementing targeted subsidies with robust plans.
... Access to credit was a positive and significant determinant of being insured in CBHI (see Table 4). This finding is similar with other studies (36,37). Credit is used as a means of financial constraints for a poor household for affordable insurance premium, therefore, a household had access of credit makes them insured in CBHI compared to a household without access of credit. ...
Household welfare is depleted by catastrophic health expenditure by forcing families to reduce the consumption of necessary goods and services, underutilization of health services, and of finally falling into the poverty trap. To mitigate such problem, the Government of Ethiopia launched CBHI schemes. Therefore, this study investigates the household welfare impact of Community based health insurance (CBHI) in the Chilga district. A multi-stage sampling technique was used to select 531 households (of which 356 were treated and 175 control groups). Probit and propensity score matching (PSM) were used to analyze the data. Probit model revealed the following: Level of education, access to credit, chronic disease, insurance premium, awareness, distance to health service, and health service waiting time are significant determinates for being insured in CBHI. The PSM method revealed that the insured households associated with visits increased by 2.6 times, reduced per-capita health expenditure by 17-14% points, increased the per-capita consumption of non-food items by 12-14% points, increased the per-capita consumption of food items by 12-13% points in a given matching algorithm compared to the counterparts. Therefore, CBHI has enhanced service utilization by reducing per-capita health expenditure and increasing consumption per-capita, in general, it improved household welfare. To this end, the results of this study suggested that the government (ministry of health) and concerned bodies (such as NGOs) should extend the coverage and accessibility of CBHI schemes, create aware to the society about CBHI, and subsidize premium costs of the poor.
... 54 The compliance of participant is also related to the availability of health services needed by the participants. 55 The results of this study are also supported by previous research which states that service quality is the main factor influencing the use of health insurance. 56 Poor quality of health services causes a person to stop participating in health insurance. ...
Background:
The study aims to explore factors that affect the compliance of Indonesia National Health Insurance (INHI) in paying the premiums.
Methods:
The study design was qualitative with grounded theory research approach and constructivism paradigm. The study was conducted in 2018 and carried out for 3 months. We recruited 22 respondents from four different cities/districts. Triangulation was carried out through 26 informants from various stakeholders. Data were analyzed through coding, categorizing and pattern matching to obtain substantive theory.
Results:
The resulting substantive theory consists of 6 constructs and 14 categories. Compliance with paying insurance premium depends on the intention to pay for contribution. Meanwhile, the intention to pay is related to internal and external factors of INHI participants. To improve payment contribution of independent participants, INHI program has to pay attention for factors originating internally from the participants themselves (understanding of INHI program, financial ability and self-attitude) and also externally such as operational system and the quality of health care.
Conclusion:
Compliance of paying insurance premium is related to internal and external factors of participants. Thus, interventions to improve compliance to pay premium should take these factors into account, and not merely on increasing the knowledge of participants.
... Health Insurance is a system of advance financing of medical expenses through contribution, premium paid into a common fund to pay for all and part of health services specified in an insurance policy or plan (Oriakhi, and Onemolease, 2012). Insurance has also been defined as a social scheme which provides financial indemnity for the effects of a misfortune. ...
In Nigeria, health Insurance has been identified as a risk transfer mechanism used primarily to hedge against an unforeseen contingency. Recently debates have revolved around extending health insurance coverage to a wider range of the population as this will ensure growth in the socioeconomic productivity in Nigeria. This study therefore examined the nexus between health insurance and socioeconomic productivity in Nigeria using descriptive research method. Findings from the study showed that there is a significant relationship between private health insurance and socioeconomic productivity. This implies that enrolees on healthcare insurance services are more productive as the out-of-pocket payment for healthcare services tend to be far lower than individuals without healthcare insurance services. The study also revealed that there is a significant relationship between hospital reimbursement benefit and economic development in Nigeria. Lastly the study revealed that accident insurance has a significant effect on economic development in Nigeria. Based on these findings the study recommends that the National Health Insurance Scheme (NHIS) should expand coverage to more persons in the rural and urban centres: while incentives should be provided to promote not-for-profit and community-based insurance schemes. It was also recommended that there is need for the introduction and enforcement of Hospital Reimbursement Benefit through public-private partnership. Finally, the study recommends that the government need to create strong awareness for the benefit of Accident insurance in order to protect the people against sudden eventualities.
... Merchants were 0.098 times less likely to join CBHI than compared to farmers (AOR=0.098; 95% CI; 0.027-0.363).The study results which is supported by the study conducted in the Edo state of Nigeria [20].This might due to the fact that households heads by merchants were more likely to have the nancial ability to cover their health care costs compared to farmer. Farther more, merchants were 0.050 times less likely join in the scheme compared to government employee(AOR= 0.050;955 CI;004-0.639). ...
Background
Community-based health insurance schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Ethiopia is a low income country with more of health spending out of pocket payment by households. Health insurance is also expected to provide financial protection because it reduces the financial risk associated with falling ill. Therefore; financial risk in the absence of health insurance is equal to the out-of-pocket expenditures because of illness.
Method
Cross-sectional community based study design was conducted by using a pretested structured questionnaire. Multi-stage cluster, simple random and systematic sampling techniques was used to select 296 households as study units which were allocated to the kebeles proportionately. The sampled households were selected using simple random sampling technique. Bivariate and multivariate logistic regression was used for analysis of variables and 95% confidence level and P value <0.05 was used to measure strength of association.
Results
A total of 296 sampled study participants, 285 participated in this study with a response rate of 96.3%.From this, (90.9%) were willing to join and (89.8%) of them were willingness to pay CBHI. the benefits of join the scheme were as follows, (86.8%) were reduce OOP expenditure, (8.3%) of them improve health status, (2.3%) were reduce the risk of severity and (2.6%) foster productivity.
Conclusions
This study showed that the proportion of willingness to join CBHI was higher than the findings of others study in the country and it is encouraging for planned strategy to expanding the scheme throughout the country. The main challenges utilization of health services in government health institutions were absence of available medicine, poor service delivery, lack of enough laboratory, health professional’s lack of good behavior and shortage of ambulance services. To alleviate such problem the government should be encourage access to health services.
... From our study, there is no significant relationship between gender and attitude (p = 0.824), as well as educational qualification and attitude ((p = 0.083) - Table 4; Respondents with post-secondary qualification however constituted the majority of those who had good and fair attitude to the NHIS). This is not in keeping with studies done by Azuogu et al., 2016 and Oriakhi and Onemolease, 2012 which illustrated that males were more willing to participate in NHIS [42,43] as well as a research carried out by Azuogu et al., 2016 which showed that majority of the respondents (49.5%) who were willing to participate in NHIS were respondents who had Secondary school qualification followed by those who had Post-secondary qualification (34.4%) [42]. ...
Health, according to the World Health Organization is defined as a state of complete physical, mental, social and spiritual wellbeing, and not merely the absence of disease or infirmity. This was a cross sectional community based descriptive study using a multi stage sampling technique in Unguwar Soya Community, Kabong, Jos North LGA, Plateau State, Nigeria with the aim of assessing and establishing the knowledge, attitude and practice of the residents to NHIS. An interviewer administered structured questionnaire was utilized and a total of 252 questionnaires were administered to the eligible members of the community. Majority of the Respondents are aged 20-29 years (33.7%). Majority of the respondents were females (63.5%), largely married (54.0%), most have attended secondary level of education (47.2%) and are mostly Artisans (32.1%) with majority earning above 30,000 naira (25.8%).59.5% of the respondents had heard about NHIIS; family and friends were the most common sources of NHIS awareness (25.5%). Majority of the respondents (49.3%) had heard about NHIS more than five years ago. Majority of the respondents (70.7%) had good attitude towards NHIS. Only 13.3% of the respondents are registered with NHIS. 88.5% of the respondents fund their health expenditures through Out-of-pocket payment. Results depicted that the index population has inadequate awareness and knowledge of the National Health Insurance Scheme. Resulting in the small portion of the population participating in the scheme. The government can come to the aid of this community and other communities by providing adequate awareness, knowledge and privilege to participate in the scheme to better their health.
... To this end, it could be said that, whenever people are assured of meeting their expectations from a particular health system, they are likely to use as well. Quality factors could be intersectional to include, but not limited to medication (Oriakhi and Onemolease 2012), service providers attitude (Adebayo et al. 2015), geographic location and proximity to service providers, as well as service provider-recipient communication (Andoh-Adjei et al. 2018), and long waiting times and efficiency of treatment regimes (Adebayo et al. 2015). In the views of Adebayo et al. (2015) and Arkorful et al. (2018), the attraction and retention of health insurance users requires for a constant intermittent neck turn look at quality factors. ...
Health insurance policies have become key social policy interventions incepted to extend healthcare to vulnerable populations. In this vein, Ghana devised a health insurance scheme in the year 2003. However, there have been concerns about quality, value, satisfaction and trust regarding healthcare and insurance usage. Using data drawn from 345 participants, our study investigates these dimensions to empirically test their predictive effects on the actual usage of health insurance. Data analysis results using the Structural Equation Modelling technique confirmed these dimensions as predictors of intention and actual usage. Our study delineates the practical, theoretical and policy implications of the study findings.
... 18 Additionally, lack of trust in the scheme, household size, and membership of town associations or unions were identified. 19 Moreover, vulnerable groups in the household affected membership status. 20 Studies are very limited in Ethiopia, A study conducted in Southwest Ethiopia showed that the age of a household head, household size, educational status, wealth status, and annual incomes as some of the determinant factors. ...
Purpose:
The Ethiopian health system has been challenged by a shortage of funds and is heavily reliant on foreign donation. However, voluntary community-based health insurance (CBHI) has been implemented to reach and cover the very large agricultural sector since 2010. Thus, the level of acceptability of the scheme needs to be regularly assessed through households' willingness to join before the nationwide rollout of the scheme. This study was intended to assess the level of willingness to join in community-based health insurance and associated factors in northwest Ethiopia.
Patients and methods:
Using a pretested structured questionnaire, a cross-sectional community-based study was conducted in 2017 in Amhara Region, northwest Ethiopia. Using a multi-stage sampling method, from 15 clusters in which CBHI was implemented, 1,179 households without CBHI membership were included as a sample for the study. Bivariable and multivariable logistic regression was fitted to assess the association between predictor variables and the outcome of interest.
Results:
Out of the total (1,179) participants, 60.5% (713) were willing to join the scheme. Households' occupation (AOR=2.26; 95% CI:=1.12-5.07), perceived good (AOR=2.21; 95% CI:=1.53-3.21), and medium (AOR=1.44; 95% CI=1.22-2.0) healthcare quality and richer wealth status (AOR=1.72; 95% CI=1.08-2.73) were associated with higher odds of willingness to join the scheme.
Conclusion:
As The study revealed that level of willingness to join is lower compared to other studies. Therefore, social protection activities for the low-income population and enhancement of the capacity of health facilities are crucial.
... This result is supported with study done in Northeast Ethiopia, 41 and Edo state of Nigeria. 43 This might be due to merchant household heads having more exposure to media to understand the benefits of CBHI. Housewife respondents were more willing to pay for CBHI compared to farmers whereas others (student, daily laborers) were less likely to be willing to pay for CBHI as compared to farmers. ...
Background:
In sub-Saharan Africa, out-of-pocket expenditures constitute approximately 40% of total healthcare expenditures, imposing huge financial burdens on the poor. To tackle the effects of out-of-pocket payment for healthcare services, Ethiopia has been focusing on implementation and expansion of a community-based health insurance (CBHI) program since 2011. This study assessed willingness to pay for CBHI scheme and associated factors among rural communities in Gemmachis district, eastern Ethiopia.
Methods:
Community-based cross-sectional study was conducted among 446 randomly selected participants in Gemmachis district from April 1 to April 30, 2019. Data were collected from participants using pretested structured questionnaires through face-to-face interview. Data were entered into EpiData version 3.1 and analyzed using SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with willingness to pay for CBHI.
Results:
A total of 440 (98.7%) participants were involved in the study. Three in every four (74.8%) participants were willing to pay for CBHI (95% CI: 70.7%, 78.9%). Primary education (AOR=5.1, 95% CI: 2.4, 11.1), being merchant (AOR=0.23, 95% CI: 0.10, 0.51), housewife (AOR=3.8, 95% CI: 1.3, 11.0), poor (AOR=2.5, 95% CI: 1.3, 4.7), illness in the last one year (AOR=3.1, 95% CI, 1.9, 5.2), good knowledge about CBHI (AOR=2.3, 95% CI: 1.5, 3.6) and access to public health facility (AOR=2.0,95% CI: 1.1, 3.7) were all significantly associated with willingness to pay for CBHI.
Conclusion:
A significant proportion of participants were willing to pay for CBHI scheme. Education, occupation, wealth status, illness in the last one year, knowledge about CBHI and access to healthcare facility were factors significantly associated with willingness to pay for CBHI. If the scheme is to serve as a means to provide access to health service, the premium for membership should be tailored and customized by individual socioeconomic factors.
... Compliance of participants is influenced by satisfaction health services [23]. Compliance of participant is also influences by the avalibility of health services needed by the participants [24]. ...
Background: There are currently 14% independent participants in Indonesia's National Health Insurance (INHI) from the overall (199 millions) participants. However, around 43.8% of them do not comply in paying the insurance premium. The purpose of the study is to explore factors that influence delinquent payment of contributions. Methods : The research design was qualitative study with phenomenology approach and constructivism paradigm. Data collected by in-depth interview and using theoretical sampling approach. We recruited 16 respondents of unpaid worker participants who arrear and who obey to pay the premiums from 4 difference cities/ districts. Triangulation was done trough 15 respondents from various stakeholders. We constructed substantive theory from data trough coding, cathegorizing and pattern matching. Results: Compliance of paying insurance premium is affected by the intention to pay for contribution. Meanwhile, the intention to pay is influenced by the understanding of INHI program, financial ability, self attitude, operational system and service quality. These constructs consist of 5 to 8 indicators. To improve payment contribution of independent participants, INHI program has to pay attention for factors originating internally from the participants themselves and also externally: social and institutional environment support and the quality of health care and financing system. Conclusions: INHI program need to improve a proper socialization, mechanisms for collecting beneficiary contributions, and strengthening the healthcare system, both for services and the implementation of the financing system.
... The results of this study also support from several studies that have been carried out by Pandula (2011);Nguyen and Luu (2013) who recommend that the characteristics of business owners become one of the determinants in making credit decisions in small businesses. Furthermore Oriakhi and Onemolease (2012) state that demographic factors are one of the factors that determine a person's participation in taking credit. Another study that supports the results of this study was also conducted by Machira, Njati, Thiane and Huka (2014) in their study of accessibility of female SME entrepreneurs in Kenya. ...
This study aims to analyze the determinant of micro, small and medium enterprises (MSMEs) on carrying out a credit loan. Primary data has been used in the analysis. The population in this study were all MSMEs in Jambi Province. Samples were taken by purposive random sampling. Total sample are 276 consisting of 163 MSMEs actors who took credit and 113 MSMEs actors who did not take credits. To analyze the factors that influence the taking of credits, a binary logit model is used. The dependent variable is the taking of credits, while the independent variables are household characteristics and individual characteristics of MSMEs actors. The results showed that the factors significantly affected the MSMEs on taking credit were the side job variables, working hours, working partners, gender, education, long established business, household expenses and account ownership.
... In the current study, respondents willingness to join an IBHI scheme was comparable with previous studies (18,19) and higher when compared to other Ethiopian studies (13,20,21), as well as a study in Edo state, Nigeria (22). The probable explanation for this similarity in the high proportions of people who are willing to join an IBHI scheme might be due to the existence of indigenous and inheritable social cooperation among Ethiopian communities, which binds them at the time of unforeseen conditions, and it have been practiced for period of years. ...
Introduction: The total health spending in Ethiopia (both public and private) is still limited and compromises purchase of desired healthcare. There has recently been an increase in interest in health insurance as a promising approach to healthcare financing reform in Ethiopia. Iddirs (indigenous community self-help institutions) appear to have good management practices and are successful in mobilizing communities. This study aimed to estimate the prevalence of the willingness of people in Dessie town, Northeast Ethiopia, to join an iddir-based health insurance scheme, and to identify factors associated with this prevalence. Methods: A cross-sectional study was conducted from February to March 2016 in Dessie town; 636 participants were recruited during that period. Multi-stage sampling was used to select informants and data were collected using face-to-face interviews. Both bivariable and multivariable logistic regressions were used to model the odds of willingness to participate in iddirs. Results: The proportion of people who were willing to join an Iiddir-based health insurance scheme was 83.2%. In terms of willingness to join the health insurance scheme, the odds were likely to be significantly higher among those who attended at least primary school education (AOR = 4.91; 95% CI: 2.21-10.8), those who were wealthy (AOR = 3.39; 95% CI: 1.74-6.58), and those whose family size was greater or equal to five (AOR = 3.42; 95% CI: 2.44-5.15). Being single decreases the willingness to join Iddir-based health Insurance scheme (AOR = 0.29; 95% CI: 0.14-0.55). Conclusion: Iddir association initiated health insurance scheme and considered the possible alternative source of finance for healthcare. The prevalence of willingness to join an iddir-based health insurance scheme was high. Thus, it is recommended to align insurance strategies with the scope of iddirs in order to mobilize the community for sustainable resources generation as an alternative source of finance for healthcare. [Ethiop. J. Health Dev. 2018;32(4):46-53]
... This difference might be related to the study area difference and the proportion of the female headed households involved in the study, as higher proportion of female household heads were involved in this study. Credit for medical expenses is also another predictor factor for willingness to join the scheme, this finding is supported by another study in Edo state Nigeria, which showed households which had experience of borrowing for medical expenses were more likely to join CBHI scheme [14]. This might be due to the fact that households that had experience of borrowing for medical expense can recognize the economic catastrophe of out of pocket charges. ...
Abstract
Objective: The main purpose of this research was to determine the magnitude of willingness to join to community
based health insurance (CBHI) and to identify factors associated with it.
Results: A total of 604 study participants responded for the interviews, making the response rate 98.2%. All in all, 492
(81.5%) of the study participant households were willing to join the CBHI scheme. Households which had experience
of borrowing for medical expenses within the last 12 months prior to the study were 2.7 times more likely to join CBHI
scheme than those who didn’t have borrowed (AOR=2.65; 95% CI 1.03, 6.83). Female headed households were 2.7
times more likely to take up the scheme compare to male headed households (AOR=2.74; 95% CI 1.18, 6.37). High
proportion of households was willing to join the CBHI scheme in the study area. Educational status of household
head, experience of borrowing for medical expenses, sex of household head, household animal asset as measured by
tropical livestock unit were factors found to be associated with willingness to take up CBHI scheme.
Keywords: CBHI, Ethiopia, Willingness
... Among respondents, members of the CBHI scheme, 33.54% respondents and 56.33% respondents in category two and three, respectively, do not plan to renew their CBHI membership. Surprisingly, 10.13% respondents in the first category do not plan their membership renew (Table 7). is is in line with other study conducted in Nigeria which reported the same in terms of wealth quintile members and enrolment, whereby those with high income were less likely to adhere than those with lower income [20]. Moreover, in a study conducted in Nouna, Burkina Faso, it was found that the individual of higher socioeconomic status was positively correlated with low adherence to the CBHI scheme [9]. ...
Background:
Community-based health insurance (CBHI) schemes are an emerging mechanism for providing financial protection against health-related poverty. In Rwanda, CBHI is being implemented across the country, and it is based on four socioeconomic categories of the "Ubudehe system": the premiums of the first category are fully subsidized by government, the second and third category members pay 3000 frw, and the fourth category members pay 7000 frw as premium. However, low adherence of community to the scheme since 2011 has not been sufficiently studied.
Objective:
This study aimed at determining the factors contributing to low adherence to the CBHI in rural Nyanza district, southern Rwanda.
Methodology:
A cross-sectional study was conducted in nine health centers in rural Nyanza district from May 2017 to June 2017. A sample size of 495 outpatients enrolled in CBHI or not enrolled in the CBHI scheme was calculated based on 5% margin of error and a 95% confidence interval. Logistic regression was used to identify the determinants of low adherence to CBHI.
Results:
The study revealed that there was a significant association between long waiting time to be seen by a medical care provider and between health care service provision and low adherence to the CBHI scheme (P value < 0.019) (CI: 0.09107 to 0.80323). The estimates showed that premium not affordable (P value < 0.050) (CI: 0.94119 to 9.8788) and inconvenient model of premium payment (P value < 0.001) (CI: 0.16814 to 0.59828) are significantly associated with low adherence to the CBHI scheme. There was evidence that the socioeconomic status as measured by the category of Ubudehe (P value < 0.005) (CI: 1.4685 to 8.93406) increases low adherence to the CBHI scheme.
Conclusion:
This study concludes that belonging to the second category of the Ubudehe system, long waiting time to be seen by a medical care provider and between services, premium not affordable, and inconvenient model of premium payment were significant predictors of low adherence to CBHI scheme.
... This outcome is in tandem with a number of studies previously conducted in South Africa, Nigeria, and China. 30,31,33,34 This study indicated that a household head's level of education did not have any impact in affecting the incentive to enroll in the CBHI scheme at 95% CI; however, a study conducted in Iran illustrated that independent variables such as the age of the head of household and their education would positively enhance the willingness to pay. 23 In terms of CBHI awareness, the regression model indicated a household that reported having no information or knowledge about the CBHI scheme was more likely to enroll; this phenomenon was possibly because of the fact that since households had no knowledge of the scheme, once they found out about the scheme, during the interview, they would demonstrate a great willingness to enroll. ...
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.
... Variabel tingkat pendidikan memiliki nilai odds ratio sebesar 0,33 yang artinya semakin tinggi tingkat pendidikan seorang petani penggarap akan meningkatkan peluang pengambilan keputusan untuk berpartisipasi pada pola bagi tiga sebesar 0,33 kali. Kesimpulan ini sesuai dengan apa yang dikemukakan oleh Lole (1995) dan Oriakhi et al. (2012). ...
Sharecropping system is wellknown as a disincentive agricultural system (Marshall 1920). It has been a culture that is very difficult to be deleted in rural area. Almost 70,5% of salt production business in Pamekasan regency applied this system, although it does not give more adventages to the sharecroppers. This study aimed to analyze the sharecropping system in salt production by estimating the profit taken by landlords and sharecroppers. Beside that, this study aimed to identify the factors affecting sharecropper’s decission by using binery logistic regression. The results showed that the landlords and the sharecroppers have a significant difference in the mean of their profit. This result is significant for α=5%. Sharecropper’s decission is affected significantly by the last education of sharecropper, number of sharecropper’s family, and cost of fund. This study recommended the government, landlords, sharecroppers, middleman, and the stakeholder to cooparate and make a forum that can give a better welfare to the sharecroppers.
... Given their distrust linked to negative past experiences with CBHI in Africa, potential enrollees are likely to wait and see how CBHI is evolving prior to enrolling (De Allegri et al., 2006;Defourny & Failon, 2011;Oriakhi, M A N U S C R I P T ...
In West Africa, health system funding rarely involves cross-subsidization among population segments. In some countries, a few community-based or professional health insurance programs are present, but coverage is very low. The financial principles underlying universal health coverage (UHC) sustainability and solidarity are threefold: 1) anticipation of potential health risks; 2) risk sharing and; 3) socio-economic status solidarity. In Burkina Faso, where decision-makers are favorable to national health insurance, we measured endorsement of these principles and discerned which management configurations would achieve the greatest adherence.
Community based health insurance (CBHI) schemes are increasingly recognized as potential strategy for achieving health coverage in developing countries. Health insurance is also expected to afford financial protection because it reduces the risk associated with falling ill. A community based cross‐sectional study design was employed. Multistage cluster, simple random, and systematic sampling techniques were used. A simple random sampling procedure was used tochoose the sampled household heads. The variables were analyzed using bivariate and multivariate logistic regression with a 95% confidence interval and a p‐value < 0.05, used to determine the strength of the association. This study had 285 participants, with a response rate of 96.3% out of a total of 296 sampled study participants. 90.9% of repondents were willing to join, and 89.8% were willing to pay CBHI. Based on findings joining CBHI membership provided benefits such as lower out of pocket cost (86.8%), improved health status (8.3%), reduced severity risk (2.3%), and increased productivity (2.6%). This study showed that willingness to join CBHI was higher than the findings of an other study conducted in Ethiopia. These findings are helpful for planning as well as expanding the sceme through outthe country. The main challenges to health service utilization in government health facilities are a lack of available medicine, poor service delivery, lack of laboratories, health personnel improper behavior, and ashortage of ambulance services. To address such concerns, the government should be encouraged health care access. The problems highlighted by the study subjects stated that the government health facility does not provide good health services. This led to the majority of the population paying a high cost to get treatment from a private health facility. A high number of households were willing to join and pay for the community‐based health insurance (CBHI) scheme. But utilization of health services in government organizations was low, due to the absence of available medicine, lack of enough laboratory equipment, shortage of ambulance services, poor service delivery, and health professional behavior problems. The government should improve their health service access to sustain the long‐term health care services program in Ethiopia. The problems highlighted by the study subjects stated that the government health facility does not provide good health services. This led to the majority of the population paying a high cost to get treatment from a private health facility. A high number of households were willing to join and pay for the community‐based health insurance (CBHI) scheme. But utilization of health services in government organizations was low, due to the absence of available medicine, lack of enough laboratory equipment, shortage of ambulance services, poor service delivery, and health professional behavior problems. The government should improve their health service access to sustain the long‐term health care services program in Ethiopia.
In the past two decades, community-based Health Insurance (CBHI) is expanding in most of sub-Saharan African countries with the aim of improving equitable access to health services for the informal sector population. However, population enrolment into CBHI and membership renewals thereafter remains stubbornly low. The purpose of this systematic review is to generate an evidence to better understand barriers to uptake of CBHI in sub-Saharan African countries. We systematically searched for relevant studies from databases: PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychInfo, ProQest, Excerpta Medica dataBASE (EMBASE) and Africa-Wide Information. The search strategy combined detailed terms related to (i) CBHI, (ii) enrolment/renewal and (iii) sub-Saharan African countries. A narrative synthesis of findings was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this systematic review was registered with International Prospective Register of Systematic Reviews (PROSPERO) (ref: CRD42020183959). The database search identified 4055 potential references from which 15 articles reporting on 17 studies met the eligibility criteria. The findings revealed that barriers to uptake of CBHI in sub-Saharan Africa were multidimensional in nature. Lack of awareness about the importance of health insurance, socio-economic factors, health beliefs, lack of trust towards scheme management, poor quality of health services, perceived health status and limited health benefit entitlements were reported as barriers that affect enrolments into CBHI and membership renewals. The methodological quality of studies included in this review has been found to be mostly suboptimal. The overall findings of this systematic review identified major barriers of CBHI uptake in sub-Saharan African countries which may help policymakers to make evidence-informed decisions. Findings of this review also highlighted that further research with a robust methodological quality, depth and breadth is needed to help better understand the factors that limit CBHI uptake at individual, societal and structural levels in sub-Saharan Africa.
Background: Health insurance is seen as a pathway to achieving Universal health coverage in low- and middle-income countries. The Nigeria Government has mandated states to set up social health insurance as a mechanism to offer financial protection to her citizens. However, the design of these schemes has been left to individual states. In preparation for the set-up of a contributory social health insurance scheme in Akwa Ibom State, Nigeria. This study assesses the willingness-to-pay for a social health insurance among rural residents in the state.
Methods: The study was conducted in three local government areas in Akwa Ibom State, South south Nigeria. It was a cross-sectional study with multi-stage data collection using a demand questionnaire. Interviews were conducted with 286 household heads who were bread winners. Contingent valuation using iterative bidding with double bounded dichotomous technique was used to elicit the WTP for health insurance. Multiple regression using least square method was used to create a model for predicting WTP.
Findings: About 82% of the household heads were willing to pay insurance premiums for their households. The median WTP for insurance premium was 11,142 Naira ($29), 95% CI: 9,599–12,684 Naira ($25–$33) per annum. The respondents were predominantly middle-aged (46.8%), Ibibio men (71.7%) with an average household size of five persons and bread winners who had secondary education (43.0%) and were mainly pentecostals (51.5%). The mean age of respondents was 46.4 ± 14.5 yrs. The two significant predictors of WTP for insurance premium amongst these rural residents were income of breadwinner (accounts for 79%) and size of household (2%). The regression coefficients for predicting WTP for insurance premium are intercept of 2,419, a slope of 0.1763 for Bread winner income and a slope of 741.5 household size, all values in Naira and kobo.
Conclusion: Majority of rural residents in Akwa Ibom State were willing to pay for social health insurance. The amount they were willing to pay was significantly determined by the income of the breadwinner of the household and the size of the family. These findings are relevant to designing a contributory social health insurance scheme that is affordable and sustainable in order to ensure universal health coverage for the citizens.
The main objective of this study was to determine the level of percieved benefit andbarriertowards the uptake of and willingness to enrol into the health insurance scheme in Lokoja, Kogi State, Nigeria. A cross sectional survey design was employed in this study, a total number of 335 respondents participated in this study. A structured and validated questionnaire with reliability 0.746 was used for data collection and thereafter administered to the participants through direct approach. Multi stage sampling technique method was adopted in administering 195 questionnaires on civil servants while purposive sampling was used to administer 140 questionnaires on artisans. The questionnaire was divided into seven (7) sections in order to get data on respondent's demographic characteristics, awareness, attitude, perception, perceived susceptibility, perceived benefits and perceived barriers to health insurance. Hypotheses were formulated and tested. Data analysis was done using descriptive statistics and correlation which were statistically tested at 0.05 level of significant using Pearson product moment analytical procedure.. The results revealed that the level of perceived benefits and barrier of the respondents. The study concluded that there is a low level of awareness regarding health insurance schemes among the civil servants and artisans in Kogi State. Therefore, regular seminars and trainings should be regularly conducted to disseminate information to civil servants, artisans and the general public on the benefits of health insurance scheme and also, eradicate misconceptions due to lack of adequate information.
Latar belakang dan tujuan: Sejak Januari 2010, Pemerintah Provinsi Bali melaksanakan program Jaminan Kesehatan Bali Mandara (JKBM) untuk membiayai pelayanan kesehatan masyarakat ber-KTP Bali yang belum memiliki jaminan kesehatan. Di lain pihak, sejak 1 Januari 2014, Pemerintah Pusat menyelenggarakan program Jaminan Kesehatan Nasional (JKN) dengan sistem iur biaya. Meskipun JKBM masih tersedia hingga tahun 2017, terdapat fenomena masyarakat ber-KTP Bali beralih menjadi peserta JKN mandiri kelas III. Artikel ini mengeksplorasi faktor predisposisi kepala keluarga ber-KTP Bali sehingga beralih menjadi peserta JKN mandiri kelas III dengan fasilitas kesehatan yang relatif sama.Metode: Wawancara dilakukan kepada partisipan yang dipilih secara purposive melalui exit interview dengan menggunakan pedoman wawancara mendalam pada 13 orang partisipan peserta JKN mandiri kelas III, tiga orang pimpinan wilayah, tiga orang partisipan peserta JKBM dan satu orang petugas puskesmas. Data dianalisis secara tematik dan disajikan secara narasi.Hasil: Wawancara menunjukkan partisipan yang beralih ke JKN merasa khawatir dengan sustainabilitas JKBM, kualitas layanan kesehatan dalam program JKBM dan mempersepsikan kerentanan yang tinggi terhadap penyakit dari pengalamannya memanfaatkan program JKBM sebelumnya.Simpulan: Berdasarkan pertimbangan partisipan untuk beralih kepesertaan menjadi JKN mandiri kelas III, maka dapat direkomendasikan untuk meningkatkan kerjasama antar stakeholder dalam melakukan sosialisasi JKN, terutama melalui pelibatan peserta yang telah terdaftar dan pernah memanfaatkan program JKN.
p>The Hygeia Community Health Plan was designed such that agriculture-based households can have access to affordable healthcare services. It is also aimed at providing financial risk protection against catastrophic healthcare costs which if persistent, could possibly drive them into poverty. This paper used a well-structured questionnaire to solicit responses on the effect of the Hygeia Community Health Plan on the welfare of farming households in Kwara State, Nigeria. A two-stage sampling technique was used to sample 175 farming households comprising of 115 beneficiaries and 60 non-beneficiaries from Shonga, Bacita and Lafiagi districts of Edu local government area of Kwara State, Nigeria. The ordinary least square and logit model were used in the analysis of the data for this study. The results of the analysis showed that the Hygeia community health plan was positively and statistically significant in influencing the per capita income, per capita calorie intake and the food security status of farming households in the area. Therefore, it was recommended that the government should create an enabling environment or partner with private insurance organizations. This will help them work out a plan to help rural households in other parts of the country access affordable healthcare services easily. This will help in the attainment of the universal access to health services in Kwara State and country Nigeria at large.</p
Environmental determinants causing unexpected disease rampant are seemed major challenges to be protective from inevitable hazards and to deal the future consequences in terms of human health loss. This paper explores the major environmental determinants stimulating disease prevalence in western hilly areas of Nepal. Cross-sectional analytical research design for household level primary data was treated with the binary logit regression model to identify the determinants of disease prevalence. Extreme winter temperature, decreasing winter rainfall, sporadic rain, drying spout and decreasing the tree species are the major environmental determinants; hand washing, proper management of solid waste from kitchen and habit of drinking boiled water are as household behavioral determinants; and adequate family members,higher education, use of pesticide to control the insects and use of clean cooking fuels are socioeconomic determinants encouraging disease prevalence. Plantation of large perennial and medicinal plants,proper management of warm clothes or heaters especially for old people and children having respiratory problems for extreme winter; management of water-tank for long drought in winter and community awareness campaign for the protection of spout are urgent needs for the prevention of current disease prevalence. Ergo,the recommendations are made accordingly.
Background and purpose: Since 2010, The Government of Bali has implemented local health financing (JKBM) to provide free health care services for Bali’s citizen, meanwhile, since 2014 the central government has started to implement the National Health Insurance program (JKN) based on participant’s monthly contribution. Although JKBM still available until 2017, there is a phenomenon of people who have Bali ID card turned into JKN. This article explores predisposing factors of the family head with Bali ID cards so that they switched into JKN scheme with relatively the same medical services and facilities.Methods: Interviews were conducted with purposively selected participants through the exit interview by using in-depth interview guide to 13 participants of JKN, three region leaders, three participants of JKBM and one public health central officer. Data were analyzed thematically and presented in a narrative form.Results: The interviews showed that participants who switched to JKN are concerned with sustainability and the quality of services in JKBM program. Participants perceived high vulnerability to disease from previous experience using JKBM program.Conclusion: Based on the consideration of participants to switch the membership becoming independent JKN Class III, it can be recommended improve the cooperation among stakeholders to enhance the socialization of JKN especially through the involvement of listed participants who already used JKN program.
Health insurance can be an effective tool of personal protection. But India’s health insurance market still lags behind the other countries in terms of penetration. The present article identified the role of perceptions in the enrolment of health insurance among the urban informal sector of Punjab, India. First, data were obtained from the urban informal sector of Punjab. Then factor analysis was applied to identify the perceptions associated with enrolment of health insurance. After this, logistic regression was performed to determine the associations of identified perceptions with enrolment of health insurance. The present study identified 12 perceptions factors associated with health insurance enrolment of the informal sector in India. Out of the 12 factors, the logistic regression results proved that 8 were statistically significant influencers of health insurance enrolment decisions. The significant perceptions factors were lack of awareness about the need to buy health insurance; comprehensive coverage; income constraint; future contingencies and social obligations; lack of information; availability of subsidized government health care; linkage with government hospitals; and preference for government schemes. It was found that perceptions play a vital role in the household decisions to enrol for health insurance. Policy makers or marketers of health insurance policies should recognize the household perceptions as a potential barrier and try to develop a health insurance package as per the actual needs of the informal sector (low income) in India.
How to finance and provide health care for the more than 1.3 billion rural poor and informal sector workers in low- and middle-income countries is one of the greatest challenges facing the international development community. This article presents the main findings from an extensive survey of the literature of community financing arrangements, and selected experiences from the Asia and Africa regions. Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Micro-level household data analysis indicates that community financing improves access by rural and informal sector workers to needed heath care and provides them with some financial protection against the cost of illness. Macro-level cross-country analysis gives empirical support to the hypothesis that risk-sharing in health financing matters in terms of its impact on both the level and distribution of health, financial fairness and responsiveness indicators. The background research done for this article points to five key policies available to governments to improve the effectiveness and sustainability of existing community financing schemes. This includes: (a) increased and well-targeted subsidies to pay for the premiums of low-income populations; (b) insurance to protect against expenditure fluctuations and re-insurance to enlarge the effective size of small risk pools; (c) effective prevention and case management techniques to limit expenditure fluctuations; (d) technical support to strengthen the management capacity of local schemes; and (e) establishment and strengthening of links with the formal financing and provider networks.
Using household level data and double-bounded dichotomous choice contingent valuation method, the article investigates the prospect of community health insurance schemes in mitigating the health shock effects of economic reforms and deregulations on the poor rural households of Ethiopia. The results demonstrate that the introduction of such schemes can help to protect the poor against the adverse impacts of economic reforms on health. It is also demonstrated that enough and sustainable resources can be generated from such schemes without obstructing the current economic reforms and evicting the poor and the socially disadvantaged section of the population out of the health care market.
The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in the lack of an organized financing scheme for health care, adversely affecting rural farmers' access to health care, especially among the poor. The Chinese government recently announced a policy to re-establish some forms of community-based insurance (CBI). Many existing schemes involve low premiums but high co-payments. We hypothesized that such benefit design leads to unequal distribution of the "net benefits" (NB)--benefits net of payment--because even though low premiums are more affordable to poor farmers, high co-payments may have a significant deterrent effect on the poor in the use of services in CBI. To test this hypothesis empirically, we estimated the probability of farmers joining a re-established CBI using logistic regression, and the utilization of health care services for those who joined the scheme using the two-part model. Based on the estimations, we predicted the distribution of NB among those who joined the CBI and for the entire population in the community. Our data came from a household survey of 4160 members of 1173 households conducted in six villages in Fengshan Township, Guizhou Province, China. Three principal findings emerged from this study. First, income is an important factor influencing farmers' decision to join a CBI despite the premium representing a very small fraction of household income. Secondly, both income and health status influence enrollees' utilization of health services: richer/sicker participants obtain greater NB from the CBI than poorer/healthier members, meaning that the poorer/healthier participants subsidize the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low premium and high co-payment features at every level of health status. In conclusion, policy recommendations related to the improvement of the benefit distribution of CBI schemes are made based on the results from this study.
Following a description of India's rural structure and land reform measures, discusses rural development under the following sub-headings: technology in transformation of agriculture and rural development; technological needs for future agriculture and rural development; role of credit in agriculture and rural development; and issues in improving the pace of agricultural production and rural development. -after Author
Access to public and private health insurance in rural areas of low income countries is severely constrained by high unit cost of transaction per contract due to information asymmetries between insurance sellers and buyers. This leads to a situation in which the majority of the poor have to rely on out-of-pocket expenditures when they are ill, resulting in a high vulnerability for health shocks which negatively affect the overall risk management of the household, investment and resource allocation decisions. Recently, however, in various parts of the world community based health insurance schemes have emerged and are becoming increasingly recognized as an instrument to finance health care in poor developing countries. These mutual insurance schemes often develop out of micro-finance institutions such as the Grameen Bank in Bangladesh and are based on similar principles, i.e. relying on collective shared norms, solidarity and enforcement by peers. Taking the example of "les mutuelles de santés" (mutual health organization) in rural Senegal this paper analyzes weather or not members in a mutual health insurance scheme have actually a better access to health care than non-members. A binary probit model is estimated for the determinants of participation in a mutual and a logit/log linear model is used to measure the impact on health care utilization and financial protection. Impact is measured in terms of (a) access to health care facilities, i.e. if members frequent health facilities more often than non-members controlling for age, sex, education and the frequency of illness, which capture the need for health care and the health status and (b) the amount of out-of-pocket payments in case of health care use. The results show that while the health insurance schemes reach otherwise excluded people, the poorest of the poor in the communities are not covered. As important determinants for being a member beside income, we find that religion, belonging to a certain ethnic group, access to social capital and community characteristics are important. Regarding the impact on the access to health care, members of a mutual have better access to health care services than non-members after controlling for common individual, household and community characteristics. The probability of making use of hospitalization increases by 2 %-age points with membership and expenditure in case of need is reduced by about 50% compared with non-members. Given the results from this study, community financing schemes have the potential to improve existing the risk management capacity of rural households. To reduce identified limitations of the schemes, an enlargement of the risk pool and a scaling up/linking of the schemes is, however, a prerequisite. Appropriate instruments to be further tested should include re-insurance policies, subsidies for the poorest and developing linkages to the private sector via the promotion of group insurance policies. All these instruments call for a stronger role of public health policy in rural areas of low income countries.
In the midst of high cost of health care both at the macro and micro levels, health insurance becomes a viable alternative for financing health care in Ghana. It is also a way of mobilising private funds for improving health care delivery at the macro level. This study uses a contingent valuation method to assess the willingness of households in the informal sector of Ghana to join and pay premiums for a proposed National Health Insurance scheme. Focus group discussions, in-depth and structured interviews were used to collect data for the study. There was a high degree of acceptance of health insurance in all the communities surveyed. Over 90% of the respondents agreed to participate in the scheme and up to 63.6% of the respondents were willing to pay a premium of 5000 cents or $3.03 a month for a household of five persons. Using an ordered probit model, the level of premiums households were willing to pay were found to be influenced by dependency ratio, income or whether a household has difficulty in paying for health care or not, sex, health care expenditures and education. As income increases, or the proportion of unemployed household members drop, people are willing to pay higher premiums for health insurance.
The main objective of this article is to examine the willingness to pay for a viable rural health insurance scheme through community participation in India, and the policy concerns it engenders. The willingness to pay for a rural health insurance scheme through community participation is estimated through a contingent valuation approach (logit model), by using the rural household survey on health from Karnataka State in India. The results show that insurance/saving schemes are popular in rural areas. In fact, people have relatively good knowledge of insurance schemes (especially life insurance) rather than saving schemes. Most of the people stated they are willing to join and pay for the proposed rural health insurance scheme. However, the probability of willingness to join was found to be greater than the probability of willingness to pay. Indeed, socio-economic factors and physical accessibility to quality health services appeared to be significant determinants of willingness to join and pay for such a scheme. The main justification for the willingness to pay for a proposed rural health insurance scheme are attributed from household survey results: (a) the existing government health care provider's services is not quality oriented; (b) is not easily accessible; and, (c) is not cost effective. The discussion suggests that policy makers in India should take serious note of the growing influence of the private sector and people's willingness to pay for organizing a rural health insurance scheme to provide quality and efficient health care in India. Policy interventions in health should not ignore private sector existence and people's willingness to pay for such a scheme and these two factors should be explicitly involved in the health management process. It is also argued that regulatory and supportive policy interventions are inevitable to promote this sector's viable and appropriate development in organizing a health insurance scheme.
Health insurance schemes are usually assessed according to technical indicators. This approach, however, neglects the dynamic perspective of insurance schemes as an element of people's mobilisation for participation in organising and managing health care delivery and financing. The first part of this paper describes the technical performance and the level of community involvement in management of the two largest health insurance schemes in Bangladesh, both in the rural areas and in the non-government sector. Part two discusses these achievements in light of the schemes' potential role as a mechanism for people's management of health care. A review of documents and key-informant interviews were conducted.
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