Reassessing the demand for community-based health insurance in rural Senegal: Geographic distance and awareness

Bousmah, Marwân-al-Qays; Boyer, Sylvie; Lalou, Richard; Ventelou, Bruno

doi:10.1016/j.ssmph.2021.100974

Cited by 12 publications

(19 citation statements)

References 15 publications

(19 reference statements)

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“…The national agency standardized the benefit package and insurance premium, the government subsidized 50% of the premium for all enrolees and 100% for the poor and disabled people, and the rest of the funds from the premiums are pooled to cover health care and drugs provided or prescribed by referral hospitals [ 63 ]. According to Bousmah et al, the problem was linked to the low demand for health insurance due to limited access to information about available schemes [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Factors determining membership in community-based health insurance in West Africa: a scoping review

Condé

Camara

Jallal

et al. 2022

glob health res policy

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Background In many low-income countries, households bear most of the health care costs. Community-based health insurance (CBHI) schemes have multiplied since the 1990s in West Africa. They have significantly improved their members’ access to health care. However, a large proportion of users are reluctant to subscribe to a local CBHI. Identifying the major factors affecting membership will be useful for improving CBHI coverage. The objective of this research is to obtain a general overview of existing evidence on the determinants of CBHI membership in West Africa. Methods A review of studies reporting on the factors determining membership in CBHI schemes in West Africa was conducted using guidelines developed by the Joanna Briggs Institute. Several databases were searched (PubMed, ScienceDirect, Global Health database, Embase, EconLit, Cairn.info, BDPS, Cochrane database and Google Scholar) for relevant articles available by August 15, 2022, with no methodological or linguistic restrictions in electronic databases and grey literature. Results The initial literature search resulted in 1611 studies, and 10 studies were identified by other sources. After eliminating duplicates, we reviewed the titles of the remaining 1275 studies and excluded 1080 irrelevant studies based on title and 124 studies based on abstracts. Of the 71 full texts assessed for eligibility, 32 additional papers were excluded (not relevant, outside West Africa, poorly described results) and finally 39 studies were included in the synthesis. Factors that negatively affect CBHI membership include advanced age, low education, low household income, poor quality of care, lack of trust in providers and remoteness, rules considered too strict or inappropriate, low trust in administrators and inadequate information campaign. Conclusions This study shows many lessons to be learned from a variety of countries and initiatives that could make CBHI an effective tool for increasing access to quality health care in order to achieve universal health coverage. Coverage through CBHI schemes could be improved through communication, improved education and targeted financial support.

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Section: Discussionmentioning

confidence: 99%

“…The results of surveys on the distance to health centres highlight geographic distance as a significant barrier to membership and even as a reason for disaffiliation [14,16,18,19,25,26,30,34,35,44].…”

Section: Geographical Distancementioning

confidence: 99%

Factors determining membership in community-based health insurance in West Africa: a scoping review

Condé

Camara

Jallal

et al. 2022

glob health res policy

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“…One of the potential predictors of the enrollees' satisfaction was their awareness related to the object evaluated ( 21 , 22 ). Health insurance awareness refers to individual's knowledge of the availability and coverage afforded through health insurance ( 23 , 24 ), their willingness to demand and use it ( 25 ), and their expectations with regard to its coverage, role in their own wellbeing, and implementation ( 26 ). Because of the complexity of the insurance policies, the awareness of health insurance depends on both the enrollees' education level ( 27 , 28 ) and the developments integral to the insurance industry ( 29 ).…”

Section: Literature Review and Hypothesesmentioning

confidence: 99%

“…Due to the limited number of pilot sites, not everyone has the opportunity to learn about LTCI. An awareness of the insurance program would imply that individuals have obtained knowledge about it and enjoy an opportunity to consider its value ( 23 , 25 ). Secondly, individuals value public policies and consider them to be fair when the information comes from a trusted institution ( 19 ).…”

Section: Literature Review and Hypothesesmentioning

confidence: 99%

Public trust in the long-term care insurance pilot program in China: An analysis of mediating effects

Peng

Zhang²,

Deng³

et al. 2022

Front. Public Health

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ObjectiveThis study aimed to evaluate the implementation of the long-term care insurance (LTCI) pilot program in China through an examination of public trust in the system and its associated factors of insurance awareness and satisfaction with the LTCI policy.MethodAn online survey was used to collect data from 786 participants in the city of Guangzhou, one of the pilot sites of the LTCI. Ordinal logistic regression models were used to investigate the related factors of public trust in the LTCI. Structural equation modeling (SEM) was conducted to test the mediating effect of satisfaction with LTCI policy on the relationship between insurance awareness and public trust.ResultsMore than 60% of participants gave a positive evaluation of the LTCI pilot program. More than 70% of the participants recognized the important role of the program. Both an understanding of insurance and satisfaction with LTCI policies were associated with public trust. The proportion of the indirect effect with regard to the total effect of satisfaction on trust was 70.133%, greater than the direct effect of 29.867%.ConclusionsOur findings supported the hypothesis that satisfaction with the LTCI policy plays a mediating role between insurance awareness and public trust. Optimalization of the LTCI policy was recommended to improve public trust in the LTCI program.

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“…We employed individual data from the CMUtuelleS survey, a cross-sectional survey conducted in 2019-2020 among 1787 residents of the Niakhar Health and Demographic Surveillance System (HDSS) in rural Senegal [24]. The CMUtuelleS survey aimed at characterizing the implementation of community-based health insurance (CBHI) schemes among voluntary subscribers who paid the full fee, and bene ciaries of the national cash transfer program for poor households (BSF, "Bourse de Sécurité Familale"), whose subscription to the CBHI is supposed to be subsidized [25]. Accordingly, both the subscriber/head of household and their partner were interviewed among three groups: voluntary subscribers (n = 285), BSF recipients (n = 176), and non-enrolled in a CHBI scheme (n = 1326).…”

Section: Aim Design and Setting Of The Studymentioning

confidence: 99%

Predicting health services utilization using a score of perceived barriers to medical care: evidence from rural Senegal

Coste

Bousmah

2022

Preprint

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Background: Ensuring access to healthcare services is a key element to achieving the Sustainable Development Goal 3 of promoting healthy lives and well-being through Universal Health Coverage (UHC). However, in the context of low- and middle-income countries, most studies focused on financial protection measured through catastrophic health expenditures, or on health services utilization among specific populations exhibiting health needs (such as pregnancy or recent sickness). Methods: This study aims at building an individual score of perceived barriers to medical care (PBMC) in order to predict health services utilization (or non-utilization). We estimate the score on six items: (1) knowing where to go, (2) getting permission, (3) having money, (4) distance to the facility, (5) finding transport, and (6) not wanting to go alone, using individual data from 1787 adult participants living in rural Senegal. We build the score via a stepwise descendent explanatory factor analysis (EFA), and assess its internal consistency. Finally, we assess the predictive validity of the factor-based score by testing its association (univariate regressions) with a wide range of variables on determinants of healthcare-seeking and healthcare services utilization. Results: EFA yields a one-dimensional score combining items 3-6 with a 0.7 Cronbach’s alpha indicating good internal consistency. The score is strongly associated – p-values significant at the 5% level – with determinants of healthcare-seeking (including, but not limited to, sex, education, marital status, poverty, and distance to the health facility). Additionally, the score can predict non-utilization of health services at the household level, utilization and non-utilization of health services following an individual’s episode of illness, and utilization of health services during pregnancy and birth. These results are robust to the use of a different dataset.Conclusions: As a valid, sensitive, and easily documented individual-level indicator, the PBMC score can be a complement to regional or national level health services coverage to measure health services access and predict utilization. At the individual or household level, the PBMC score can also be combined with conventional metrics of financial risk protection such as CHE to comprehensively document deficits in, and progress towards UHC.

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Reassessing the demand for community-based health insurance in rural Senegal: Geographic distance and awareness

Cited by 12 publications

References 15 publications

Factors determining membership in community-based health insurance in West Africa: a scoping review

Factors determining membership in community-based health insurance in West Africa: a scoping review

Public trust in the long-term care insurance pilot program in China: An analysis of mediating effects

Predicting health services utilization using a score of perceived barriers to medical care: evidence from rural Senegal

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