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Community-based health insurance and access to maternal health services: Evidence from three West African countries

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  • Smith, Kimberly V.
  • Sulzbach, Sara

Abstract

Community-based health insurance (CBHI) has been incorporated into the health financing strategies of governments and communities in several Sub-Saharan African countries. Despite the support for and proliferation of CBHI schemes in this region, empirical evidence on how CBHI impacts access to health care, particularly maternal health services, is very limited. We use recent household surveys in three West African countries - Senegal, Mali, and Ghana - to examine the relationship between CBHI membership and access to formal sector maternal health care. We find that membership in a CBHI scheme is positively associated with the use of maternal health services, particularly in areas where utilization rates are very low and for more expensive delivery-related care. Our findings suggest, however, that membership in a CBHI scheme is not sufficient to influence maternal health behaviors - it is the inclusion of maternal health care in the benefits package that makes a difference. While many questions remain about CBHI, this study provides preliminary evidence suggesting that CBHI is a potential demand-side mechanism to increase maternal health care access. However, complementary supply-side interventions to improve quality of and geographic access to health care are also critical for improving health outcomes in this region.

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  • 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.
    • Handle: RePEc:eee:socmed:v:66:y:2008:i:12:p:2460-2473
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    1. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2015. "Enrollment in Ethiopia’s Community-Based Health Insurance Scheme," World Development, Elsevier, vol. 74(C), pages 58-76.
    2. Sheikh Aftaab Ul Maroof & Mohi-ud-Din Sangmi, 2021. "Assessing financial impact of a health intervention program and controlling spillover effects," DECISION: Official Journal of the Indian Institute of Management Calcutta, Springer;Indian Institute of Management Calcutta, vol. 48(1), pages 15-25, March.
    3. Emily Gustafsson-Wright & Gosia Popławska & Zlata Tanović & Jacques Gaag, 2018. "The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 221-276, September.
    4. 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.
    5. Muhammad Badiuzzaman & Syed Mansoob Murshed, 2016. "Impact of post-conflict development interventions on maternal healthcare utilization," WIDER Working Paper Series 082, World Institute for Development Economic Research (UNU-WIDER).
    6. Veronica Vargas & Sayem Ahmed & Alayne M Adams, 2018. "Factors enabling comprehensive maternal health services in the benefits package of emerging financing schemes: A cross-sectional analysis from 1990 to 2014," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-15, September.
    7. Stéphanie Degroote & Valery Ridde & Manuela Allegri, 2020. "Health Insurance in Sub-Saharan Africa: A Scoping Review of the Methods Used to Evaluate its Impact," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 825-840, December.
    8. Martine Audibert & Emmanuel Bonnet & Alexandre Dumont & A. N'Landu & Bertille Raffalli & Andrainolo Ravalihasy & M. Ravit & Valéry Ridde & Flore Apolline Roy, 2019. "Impacts du forfait obstétrical en Mauritanie sur l'offre, le recours et les inégalités d'accès aux soins : synthèse du rapport final," Post-Print hal-03834803, HAL.
    9. Jacopo Bonan & Oliver Dagnelie & Philippe LeMay-Boucher & Michel Tenikue, 2012. "Is it all about Money? A Randomized Evaluation of the Impact of Insurance Literacy and Marketing Treatments on the Demand for Health Microinsurance in Senegal," Working Papers 216, University of Milano-Bicocca, Department of Economics, revised Jan 2012.
    10. Taiwo Obembe & Sharon Fonn, 2020. "Affording unavoidable emergency surgical care – The lived experiences and payment coping strategies of households in Ibadan metropolis, Southwestern Nigeria," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-18, May.
    11. 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).
    12. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Abebaw, Degnet & Alemu, Getnet & Bedi, Arjun S., 2019. "The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care," Social Science & Medicine, Elsevier, vol. 220(C), pages 112-119.
    13. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2015. "Impact of Ethiopia's Community Based Health Insurance on Household Economic Welfare," The World Bank Economic Review, World Bank, vol. 29(suppl_1), pages 164-173.
    14. Marion Ravit & Andrainolo Ravalihasy & Martine Audibert & Valery Ridde & Emmanuel Bonnet & Bertille Raffalli & Flore-Apolline Roy & Anais N’landu & Alexandre Dumont, 2020. "The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis," Post-Print hal-02509190, HAL.
    15. 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.
    16. 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.
    17. Wagner, Natascha & Quimbo, Stella & Shimkhada, Riti & Peabody, John, 2018. "Does health insurance coverage or improved quality protect better against out-of-pocket payments? Experimental evidence from the Philippines," Social Science & Medicine, Elsevier, vol. 204(C), pages 51-58.
    18. Yi Yao & Joan Schmit & Julie Shi, 2019. "Promoting sustainability for micro health insurance: a risk-adjusted subsidy approach for maternal healthcare service," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(3), pages 382-409, July.
    19. Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2014. "Dropping out of Ethiopia’s Community Based Health Insurance scheme," ISS Working Papers - General Series 76960, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    20. Salaheddine El Omari & Mahmoud Karasneh, 2021. "Social health insurance in the Philippines: do the poor really benefit?," Journal of Economics and Finance, Springer;Academy of Economics and Finance, vol. 45(1), pages 171-187, January.
    21. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
    22. Samarakoon, Shanika & Parinduri, Rasyad, 2015. "Social health insurance improves women’s healthcare use: Evidence from Indonesia," MPRA Paper 61504, University Library of Munich, Germany.
    23. Muhammad Badiuzzaman & Syed Mansoob Murshed, 2016. "Impact of post-conflict development interventions on maternal healthcare utilization," WIDER Working Paper Series wp-2016-82, World Institute for Development Economic Research (UNU-WIDER).

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