Background
Mutual health insurance schemes are a tool to curb excessive out-of-pocket payments for healthcare services to the poor and vulnerable communities. However, the uptake and utilization of these insurance schemes are low. This study explores factors that influence the uptake and utilization of mutual health insurance schemes.
Methods
This was a descriptive qualitative case study conducted among 20 Adherents and seven staff of BEPHA Kumbo. Multiple data sources were used, including semi-structured interviews, focus group discussions, and a review of documents. We used the content analysis method to analyze the data.
Results
This study found multiple level factors; individual, community, and system factors that influenced uptake and utilization of MHI schemes. The study revealed that reliability in the scheme, membership criteria and access to the insurer were enablers. At the same time, annual contribution fees, adverse selection, and the lack of national HMI policy were threats influencing uptake and utilization of MHI schemes.
Conclusions
MHI schemes can expand coverage and increase access to healthcare services among marginalized and vulnerable people in the community and prevent them from plunging into perpetual impoverishment. However, the factors identified influence them either negatively or positively from performing to the optimum.
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