Journal Article

A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries

Uthman, Olalekan A., Wiysonge, Charles S., Stern, Erin A., Adebayo, Esther F., Ataguba, John E., Lamont, Kim T.

2015

Overview

Background Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs. Methods We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review. Results Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment. Conclusion In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers’ access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adult / Aged / Case studies / Community Networks / Developing Countries / Economic reform / Employment - economics / Female / Health Administration / Health care expenditures / Health care industry / Health care policy / Health care reform / Health Informatics / Health insurance / Households / Humans / Informal economy / Insurance coverage / Insurance Coverage - statistics & numerical data / Insurance, Health - economics / Low income groups / Male / Medical care / Medicine / Medicine & Public Health / Middle Aged / National health insurance / Nursing Research / Observational studies / Poverty / Prepayments / Public Health / Quality management / Research Article / Rural areas / Social capital / Systematic review / Universal Health Insurance / Valuation / Willingness to pay