Year: 2013
Type: dissertation
Abstract: Community-Based Health Insurance Schemes (CBHIs) have flourished all over the developing\nworld. CBHI is a not-for-profit type of health insurance that has been used by poor people to\nprotect themselves against the high costs of seeking medical care and treatment for illness. In\nprinciple, CBHI schemes are designed for people who live and work in rural areas, or in the\ninformal sector. Most often, these people are unable to access adequate public, private, or\nemployer-sponsored health insurance. Significantly, by reaching those who would otherwise\nhave no financial protection against the cost of illness, CBHIs also contribute to equity in the\nhealth sector. However, many schemes do not perform well due to a number of problems related\nto their implementation. This study examines then the problems related to the implementation of\nCBHIs in the developing world. In addition, the study presents possible strategies to overcome\nthose problems. It also draws lessons from the case of Rwanda, generally considered a success\nstory in the implementation of CBHIs.\nMethodologically, extensive literature review and informal interviews are two methods used to\ntackle the research questions.\nThe review found that the main challenges of CBHI are related to insurance risks that include\nadverse selection and moral hazard. There are also challenges related to the context in which\nCBHIs are launched such as the absence of formal insurance culture and poverty, which lead to\nlow levels of revenues that can be mobilized from poor communities. Furthermore, the study\ndiscusses problems related to design features that hinder the performance of CBHI. Those\nproblems include, among others, the small size of the risk pool, under pricing and the limited\nmanagement capacity that exists in rural and low-income contexts.\nTo remedy to those problems, the literature proposes different strategies: increased and well\ntargeted subsidies to pay for the premiums of low income populations; educational and\nawareness-raising programs for behavior change; mandatory enrollment to fight against adverse\nselection; regular training to enhance management skills; and community participation\nFinally, the study draws lessons from success stories of implementation in Rwanda.
Author: Yvonne Habiyonizeye
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1638220602