The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda

Woldemichael, Andinet; Gurara, Daniel; Shimeles, Abebe

doi:10.5089/9781484398074.001

Cited by 18 publications

(15 citation statements)

References 17 publications

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“…Willingness to pay means the maximum (non-zero) amount that households are willing to pay for the insurance scheme, elicited through a double bounded contingent valuation method specifically by applying a bidding game. 8,22 The wealth index questionnaire was adapted from Ethiopian Health Insurance Agency on the number and kinds of consumer goods they own, housing characteristics, and availability of basic amenities for residents. 28 From these, scores were derived using principal component analysis and were classified into five quintiles.…”

Section: Methodsmentioning

confidence: 99%

“…7 Among the prepaid mechanisms, health insurances improve access to quality health-care services, protecting households from health-related financial risks, and ultimately improving the health status of the poor. 8 Of these, community-based health insurance (CBHI) is one means of pooling risks across different population groups so that it significantly reduces the financial burden of catastrophic illnesses for individuals. 9 CBHI reduces direct out-ofpocket payment at the point of service delivery and improves cost recovery, though its effect on crosssubsidy is questionable.…”

Section: Introductionmentioning

confidence: 99%

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<p>Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia</p>

Garedew¹,

Ololo²,

Handalo³

et al. 2020

CEOR

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Background: Globally, millions of people suffer and die because they do not have the money to pay for health care. A voluntary health insurance scheme is a prepayment mechanism to overcome the financial hardship of poor households. There is a high demand to determine the enrolment rate and ability to pay before scale-up of the scheme by the government to be sure of its feasibility and sustainability. Objective: To determine willingness to join and pay for a community-based health insurance scheme and associated factors among rural households of selected districts in Jimma Zone, 2018. Methods: A community-based cross-sectional study design was employed in selected districts of Jimma Zone, Ethiopia. Multistage simple random sampling was used to select 422 households. Data were collected using a semi-structured interviewer-administered questionnaire. A double bounded contingent valuation method was applied to elicit households' willingness to pay for the scheme. Data were entered into Epi-Data 3.1 and analyzed with SPSS V.23. A binary logistic regression model was fitted to determine the presence of statistically significant associations between the dependent and independent variables at p-value <0.05 and AOR values with 95% CI. Results: Of 422 sampled respondents, 389 participated in this study with a response rate of 92%. Of these, 305 (78%) were willing to join and 274 (90%) of them were willing to pay. The average amount of money the households were willing to pay per household per annum was 228 ETB (8.27 USD), with a range of 100-500 ETB. The older age groups, poor households, and experience of local risk-sharing schemes were found to be determinants for willingness to join the community-based health insurance. Similarly, having a large family size, and low economic and education status of households were significant predictors of willingness to pay for this scheme. Conclusion: A high proportion of households were willing to join and pay for the CBHI scheme. The average amount of money they were willing to pay for the scheme was very slightly lower than what is planned by the government. Thus, the government of Ethiopia should strengthen efforts to scale up this scheme in the rural areas of the country specifically to districts not yet enrolled, to reduce direct out-of-pocket payment at service delivery points. This will also contribute to guaranteeing dwellers of rural areas access to quality health services without facing financial hardship, to achieve universal health coverage for all by the end of 2035.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia</p>

Garedew¹,

Ololo²,

Handalo³

et al. 2020

CEOR

View full text Add to dashboard Cite

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“…In the case of persons with MD, aside from the availability of strategies to prevent CHE, mechanisms of access for protecting households from health-related financial risks are not widely available, as has been reported in the literature (Woldemichael et al ., 2019 ). Moreover, there is a disparity between medical attention provided to the population for physical health and attention provided for mental health (Lavie-Ajayi et al ., 2018 ), due in part to the extent of poverty, the segmentation and fragmentation of the health system, and the lack or unequal distribution of financial, physical, and human resources in the health system (Laurell, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

“…This finding gives more support to our results, in the sense that these households face adverse social conditions such as lower formal education, lower probability to have formal and well-paid employment, and consequently have lower income. In this context, it is notable that in the present study, we found that household income level was a major determinant of the probability of CHC, and similar results have been reported in other studies (Zuvekas and Selden, 2010 ; Rezaei and Hajizadeh, 2019 ; Tirgil et al ., 2019 ; Woldemichael et al ., 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder

et al. 2021

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Background There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE). Objective The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico. Methods A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model. Results In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE. Conclusion Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.

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“…Taxes and health insurance are the means recommended by the WHO to raise funds for the health sector in low and middle-income countries in order to achieve UHC (including financial risk protection) [ 2 , 6 ]. Taxes and health insurance have shown good results in other African countries such as Ghana and Rwanda providing increased financial risk protection and increased service utilization [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Household preferences and willingness to pay for health insurance in Kampala City: a discrete choice experiment

Kalyango

Kananura

Ekirapa-Kiracho

2021

Cost Eff Resour Alloc

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Introduction Uganda is in discussions to introduce a national health insurance scheme. However, there is a paucity of information on household preferences and willingness to pay for health insurance attributes that may guide the design of an acceptable health insurance scheme. Our study sought to assess household preferences and willingness to pay for health insurance in Kampala city using a discrete choice experiment. Methods This study was conducted from 16th February 2020 to 10th April 2020 on 240 households in the Kawempe division of Kampala city stratified into slum and non-slum communities in order to get a representative sample of the area. We purposively selected the communities that represented slum and non-slum communities and thereafter applied systematic sampling in the selection of the households that participated in the study from each of the communities. Four household and policy-relevant attributes were used in the experimental design of the study. Each respondent attended to 9 binary choice sets of health insurance plans that included one fixed choice set. Data were analyzed using mixed logit models. Results Households in both the non-slum and slum communities had a high preference for health insurance plans that included both private and public health care providers as compared to plans that included public health care providers only (non-slum coefficient β = 0.81, P < 0.05; slum β = 0.87, p < 0.05) and; health insurance plans that covered extended family members as compared to plans that had limitations on the number of family members allowed (non-slum β = 0.44, P < 0.05; slum β = 0.36, p < 0.05). Households in non-slum communities, in particular, had a high preference for health insurance plans that covered chronic illnesses and major surgeries to other plans (0.97 β, P < 0.05). Our findings suggest that location of the household influences willingness to pay with households from non-slum communities willing to pay more for the preferred attributes. Conclusion Potential health insurance schemes should consider including both private and public health care providers and allow more household members to be enrolled in both slum and non-slum communities. However, the inclusion of more HH members should be weighed against the possible depletion of resources and other attributes. Potential health insurance schemes should also prioritize coverage for chronic illnesses and major surgeries in non-slum communities, in particular, to make the scheme attractive and acceptable for these communities.

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The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda

Cited by 18 publications

References 17 publications

<p>Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia</p>

<p>Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia</p>

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder

Household preferences and willingness to pay for health insurance in Kampala City: a discrete choice experiment

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