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The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso

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  • Gnawali, Devendra Prasad
  • Pokhrel, Subhash
  • Sié, Ali
  • Sanon, Mamadou
  • De Allegri, Manuela
  • Souares, Aurélia
  • Dong, Hengjin
  • Sauerborn, Rainer

Abstract

Objective To quantify the impact of community-based health insurance (CBI) on utilization of health care services in rural Burkina Faso.Methods Propensity score matching was used to minimise the observed baseline differences in the characteristics of insured and uninsured groups such that the observed difference in healthcare utilisation could generally be attributed to the CBI.Results Compared with those who were not enrolled in the CBI, the overall increase in outpatient visits given illness in the insured group was about 40% higher, while the differential effect on utilization of inpatient care between insured and non-insured groups was insignificant. Not only were the very poor less likely to enroll in CBI, but even once insured, they were less likely to utilize health services compared to their wealthier counterparts.Conclusions The overall effect of CBI on health care utilization is significant and positive but the benefit of CBI is not equally enjoyed by all socioeconomic groups. The policy implications are: (a) there is a need to subsidize the premium to favor the enrolment of the very poor; and (b) various measures need to be placed in order to maximize the population's capacity to enjoy the benefits of insurance once insured.

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  • Gnawali, Devendra Prasad & Pokhrel, Subhash & Sié, Ali & Sanon, Mamadou & De Allegri, Manuela & Souares, Aurélia & Dong, Hengjin & Sauerborn, Rainer, 2009. "The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso," Health Policy, Elsevier, vol. 90(2-3), pages 214-222, May.
    • Handle: RePEc:eee:hepoli:v:90:y:2009:i:2-3:p:214-222
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    3. David Mark Dror, 2018. "What Factors Affect Voluntary Uptake of Community-based Health Insurance Schemes in Lowand Middle-Income Countries? A Systematic Review and Meta-Analysis," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 14, pages 271-306, World Scientific Publishing Co. Pte. Ltd..
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    9. Andinet Woldemichael & Daniel Gurara & Abebe Shimeles, 2019. "The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda," IMF Working Papers 2019/038, International Monetary Fund.
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    11. David Mark Dror, 2018. "Enrollment in Community-based Health Insurance Schemes in Rural Bihar and Uttar Pradesh, India," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 17, pages 345-363, World Scientific Publishing Co. Pte. Ltd..
    12. Woldemichael, Andinet & Gurara, Daniel Zerfu & Shimeles, Abebe, 2016. "Community-Based Health Insurance and Out-of-Pocket Healthcare Spending in Africa: Evidence from Rwanda," IZA Discussion Papers 9922, Institute of Labor Economics (IZA).
    13. Khaled Makhloufi & Bruno Ventelou & Mohammad Abu-Zaineh, 2015. "Have health insurance reforms in Tunisia attained their intended objectives?," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 29-51, March.
    14. Sodokin, Koffi & Djafon, Joseph Kokouvi & Dandonougbo, Yevessé & Akakpo, Afi & Couchoro, Mawuli K. & Agbodji, Akoété Ega, 2023. "Technological change, completeness of financing microstructures, and impact on well-being and income inequality," Telecommunications Policy, Elsevier, vol. 47(6).
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    16. Sayem Ahmed & Abdur Razzaque Sarker & Marufa Sultana & Sanchita Chakrovorty & Mohammad Wahid Ahmed & Farzana Dorin & Andrew J Mirelman & Ziaul Islam & Mohammad Hafizur Rahman & Louis W Niessen & Clas , 2018. "The impact of community-based health insurance on the utilization of medically trained healthcare providers among informal workers in Bangladesh," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-16, July.
    17. Robyn, Paul Jacob & Fink, Günther & Sié, Ali & Sauerborn, Rainer, 2012. "Health insurance and health-seeking behavior: Evidence from a randomized community-based insurance rollout in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 75(4), pages 595-603.
    18. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    19. Hiwot Tilahun & Desta Debalkie Atnafu & Geta Asrade & Amare Minyihun & Yihun Mulugeta Alemu, 2018. "Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia," Health Economics Review, Springer, vol. 8(1), pages 1-7, December.
    20. Robyn, Paul Jacob & Bärnighausen, Till & Souares, Aurélia & Traoré, Adama & Bicaba, Brice & Sié, Ali & Sauerborn, Rainer, 2014. "Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study," Social Science & Medicine, Elsevier, vol. 108(C), pages 223-236.
    21. Muluken Genetu Chanie & Gojjam Eshetie Ewunetie, 2020. "Determinants of enrollment in community based health insurance among Households in Tach-Armachiho Woreda, North Gondar, Ethiopia, 2019," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-10, August.
    22. Parmar, Divya & Souares, Aurélia & de Allegri, Manuela & Savadogo, Germain & Sauerborn, Rainer, 2012. "Adverse selection in a community-based health insurance scheme in rural Africa: implications for introducing targeted subsidies," LSE Research Online Documents on Economics 46664, London School of Economics and Political Science, LSE Library.
    23. Rabbani, Atonu & Mehareen, Jeenat & Chowdhury, Imran Ahmed & Sarker, Malabika, 2022. "Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment," Social Science & Medicine, Elsevier, vol. 292(C).
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