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The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns

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  • Criel, Bart
  • Van der Stuyft, Patrick
  • Van Lerberghe, Wim

Abstract

The Bwamanda hospital insurance scheme in Zaire was launched in the mid-eighties and is one of the few well-established and documented initiatives in the field of district-based insurance schemes in sub-Saharan Africa. It was established that hospital utilization in Bwamanda is significantly higher among the insured population. A higher hospital utilization is however not a goal in itself: it is a positive phenomenon if it takes place for problems where the hospital's know-how and technology are needed to solve the patient's problem. This paper investigates the effect of the insurance scheme on hospital utilization patterns. More specifically, the distribution of this higher utilization over the different hospital departments, as well as its spatial distribution in the entire district area are analyzed. The impact of the insurance scheme on the effectiveness, equity and efficiency of hospital utilization are discussed. The relevance and possible implications of these findings on the design of the Bwamanda insurance scheme are discussed. Finally, it is argued that the methods used in the present study contribute to a coherent framework for the evaluation of similar initiatives.

Suggested Citation

  • Criel, Bart & Van der Stuyft, Patrick & Van Lerberghe, Wim, 1999. "The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns," Social Science & Medicine, Elsevier, vol. 48(7), pages 897-911, April.
    • Handle: RePEc:eee:socmed:v:48:y:1999:i:7:p:897-911
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    Cited by:

    1. Slim Haddad & Valery Ridde & Ismaelou Yacoubou & Geneviève Mák & Michel Gbetié, 2012. "An Evaluation of the Outcomes of Mutual Health Organizations in Benin," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-8, October.
    2. Sinha, Tara & Ranson, M. Kent & Mills, Anne J., 2007. "Protecting the Poor? The Distributional Impact of a Bundled Insurance Scheme," World Development, Elsevier, vol. 35(8), pages 1404-1421, August.
    3. Fernando Ruiz & Liliana Amaya & Stella Venegas, 2007. "Progressive segmented health insurance: Colombian health reform and access to health services," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 3-18, January.
    4. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    5. Hua You & Hai Gu & Weiqing Ning & Hua Zhou & Hengjin Dong, 2016. "Comparing Maternal Services Utilization and Expense Reimbursement before and after the Adjustment of the New Rural Cooperative Medical Scheme Policy in Rural China," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-10, July.
    6. Smith, Kimberly V. & Sulzbach, Sara, 2008. "Community-based health insurance and access to maternal health services: Evidence from three West African countries," Social Science & Medicine, Elsevier, vol. 66(12), pages 2460-2473, June.
    7. World Bank, 2008. "Democratic Republic of Congo : Public Expenditure Review," World Bank Publications - Reports 8117, The World Bank Group.
    8. Buor, Daniel, 2003. "Mothers' education and childhood mortality in Ghana," Health Policy, Elsevier, vol. 64(3), pages 297-309, June.
    9. Paul Marschall & Steffen Flessa, 2008. "Expanding access to primary care without additional budgets? A case study from Burkina Faso," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 393-403, November.

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