Dataset Information

Do household perceptions influence enrolment decisions into community-based health insurance schemes in Tanzania?

ABSTRACT:

Background

Several countries including Tanzania, have established voluntary non-profit insurance schemes, commonly known as community-based health insurance schemes (CBHIs), that typically target rural populations and the informal sector. This paper considers the importance of household perceptions towards CBHIs in Tanzania and their role in explaining the enrolment decision of households.

Methods

This was a cross-sectional household survey that involved 722 households located in Bahi and Chamwino districts in the Dodoma region. A three-stage sampling procedure was used, and the data were analyzed using both factor analysis (FA) and principal component analysis (PCA). Statistical tests such as Bartlett's test of sphericity, Kaiser-Meyer-Olkin (KMO) for sampling adequacy, and Cronbach's alpha test for internal consistency and scale reliability were performed to examine the suitability of the data for PCA and FA. Finally, multivariate logistic regressions were run to determine the associations between the identified factors and the insurance enrolment status.

Results

The PCA identified seven perception factors while FA identified four factors. The quality of healthcare services, preferences (social beliefs), and accessibility to insurance scheme administration (convenience) were the most important factors identified by the two methods. Multivariate logistic regressions showed that the factors identified from the two methods differed somewhat in importance when considered as independent predictors of the enrollment status. The most important perception factors in terms of strength of association (odds ratio) and statistical significance were accessibility to insurance scheme administration (convenience), preferences (beliefs), and the quality of health care services. However, age and income were the only socio-demographic characteristics that were statistically significant.

Conclusion

Household perceptions were found to influence households' decisions to enroll in CBHIs. Policymakers should recognize and consider these perceptions when designing policies and programs that aim to increase the enrolment into CBHIs.

SUBMITTER: Kagaigai A

PROVIDER: S-EPMC7893739 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Do household perceptions influence enrolment decisions into community-based health insurance schemes in Tanzania?

Kagaigai Alphoncina A Anaeli Amani A Mori Amani Thomas AT Grepperud Sverre S

BMC health services research 20210219 1

<h4>Background</h4>Several countries including Tanzania, have established voluntary non-profit insurance schemes, commonly known as community-based health insurance schemes (CBHIs), that typically target rural populations and the informal sector. This paper considers the importance of household perceptions towards CBHIs in Tanzania and their role in explaining the enrolment decision of households.<h4>Methods</h4>This was a cross-sectional household survey that involved 722 households located in ...[more]

PMID: 33607977

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Project description:Community-based health insurance (CBHI) has been implemented in many low- and middle-income countries to increase financial risk protection in populations without access to formal health insurance. While the design of such social programmes is fundamental to ensuring equitable access to care, little is known about the operational and structural factors influencing enrolment in CBHI schemes. In this study, we took advantage of newly established data monitoring requirements in Senegal to explore the association between the operational capacity and structure of CBHI schemes-also termed 'mutual health organizations' (MHO) in francophone countries-and their enrolment levels. The dataset comprised 12 waves of quarterly data over 2017-2019 and covered all 676 MHOs registered in the country. Primary analyses were conducted using dynamic panel data regression analysis. We found that higher operational capacity significantly predicted higher performance: enrolment was positively associated with the presence of a salaried manager at the MHO level (12% more total enrolees, 23% more poor members) and with stronger cooperation between MHOs and local health posts (for each additional contract signed, total enrolees and poor members increased by 7% and 5%, respectively). However, higher operational capacity was only modestly associated with higher sustainability proxied by the proportion of enrolees up to date with premium payment. We also found that structural factors were influential, with MHOs located within a health facility enrolling fewer poor members (-16%). Sensitivity analyses showed that these associations were robust. Our findings suggest that policies aimed at professionalizing and reinforcing the operational capacity of MHOs could accelerate the expansion of CBHI coverage, including in the most impoverished populations. However, they also suggest that increasing operational capacity alone may be insufficient to make CBHI schemes sustainable over time.

Project description:ObjectivesCommunity-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance.MethodsWe conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010.ResultsInformation on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme.ConclusionCBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic.

Project description:BackgroundCommunity Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. There are pocket studies on CBHI scheme with different coverage in Ethiopia and there is no pooled study on CBHI enrolment coverage in Ethiopia for better understanding the scheme and decision making. The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications.MethodsThe systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I2 test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model.ResultAmong 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97 (95%CI: 41.68, 69.77) in earlier (2016-2017) studies than recent 37.33 (95%CI: 24.82, 50.77) studies (2018-2020).ConclusionThe pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. The finding of the study helps national decision making for CBHI scheme service improvement. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages.Trial registrationThe protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762 .

Project description:BACKGROUND:The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households' decisions to enrol and renew membership in these schemes. METHODS:We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. RESULTS:Results revealed that household's socioeconomic status, husband's employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. CONCLUSION:While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.

Project description:BackgroundMany studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal.MethodsWe employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable.ResultsData showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41-60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17-44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09-8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61-8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34-2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI.ConclusionKnowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.

Dataset Information

Do household perceptions influence enrolment decisions into community-based health insurance schemes in Tanzania?

Background

Methods

Results

Conclusion

Publications

Do household perceptions influence enrolment decisions into community-based health insurance schemes in Tanzania?

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