Factors Associated with Membership in a Mutual Health Insurance Fund in the Thiès Region (Senegal) in 2023: Article

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Abstract

 Introduction : Mutual health insurance constitutes a micro-insurance system which facilitates access to care by avoiding direct payment. They represent one of the pillars of our Universal Health Coverage. After years of existence and despite political commitment, community support for mutual health insurance remains low until now. The objective of our work was to study the factors linked to the membership of mutual health insurance companies in the Thiès region and to propose solutions.  Methodology : The study was cross-sectional, descriptive and analytical. It was carried out among a sample of 1,300 people, residing in the Thiès region for at least 6 months, chosen following a three-stage cluster survey. A questionnaire was used to collect data related to predisposing, facilitating and health system factors. These data were entered and analyzed using SPSS version 21 software. The significance value was P < 0.05. The Odds ratio was used to measure the strength of the link.  Results : The average age is 42 years and among the people surveyed 75.3% lived in an urban area, 84.5% claimed to know mutual insurance companies. The number of dependent children among the people surveyed was 9 and 90% had an income-generating activity, married people were 82.9% and 78.2% were educated. The mutual penetration rate was 69.3%. The analysis showed that membership in mutual health insurance was significantly influenced by the area of residence with P < 0.001 [OR: 2.0; CI:1.4-2.8], by age group with P < 0.001[OR:1.4; CI:1.1-2.0], by income-generating activity with P < 0.001 [OR:2.1; CI:1.1-4.1], by knowledge of a mutual with P < 0.001 [OR:81.6; CI: 42.2-157] and education with P < 0.001 [OR: 1.9; CI: 1.3-2.6]. Membership was also associated with marital status and the number of children in care with P < 0.001 and P < 0.002 respectively.  Conclusion : This study made it possible to evaluate the penetration rate of mutual health insurance in the Thiès region in 2023, but also to identify the factors associated with membership in a mutual health insurance. Strengthening communication and targeted awareness and improving the level of knowledge of the populations will help to boost the level of support of the populations of the Thiès region.

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Community-based health insurance in low-income countries: a systematic review of the evidence.

B Ekman (2004)

Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.

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

Devendra Prasad Gnawali, Subhash Pokhrel, Ali Sié … (2009)

To quantify the impact of community-based health insurance (CBI) on utilization of health care services in rural Burkina Faso. 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. 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. 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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Community health insurance in Uganda: why does enrolment remain low? A view from beneath.

Robert Basaza, Bart Criel, Patrick Van der Stuyft (2008)

Community Health Insurance (CHI) in Uganda faces low enrolment despite interest by the Ugandan health sector to have CHI as an elaborate health sector financing mechanism. User fees have been abolished in all government facilities and CHI in Uganda is limited to the private not for profit sub-sector, mainly church-related rural hospitals. In this study, the reasons for the low enrolment are investigated in two different models of CHI. Focus group discussions and in-depth interviews were carried out with members and non-members of CHI schemes in order to acquire more insight and understanding in people's perception of CHI, in their reasons for joining and not joining and in the possibilities they see to increase enrolment. This study, which is unprecedented in East Africa, clearly points to a mixed understanding on the basic principles of CHI and on the routine functioning of the schemes. The lack of good information is mentioned by many. Problems in ability to pay the premium, poor quality of health care, the rigid design in terms of enrolment requirements and problems of trust are other important reasons for people not to join. Our findings are grossly in line with the results of similar studies conducted in West Africa even if a number of context-specific issues have been identified. The study provides relevant elements for the design of a national policy on CHI in Uganda and other sub-Saharan countries.