Assessing effectiveness of a community based health insurance in rural Burkina Faso

• Published in: BMC health services research Vol. 12; no. 1; p. 363
• Main Authors: Hounton, Sennen, Byass, Peter, Kouyate, Bocar
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19.10.2012; BioMed Central; BMC
• Subjects: Adverse selection; Advisors; Age; Analysis; Anemia; Anemia - epidemiology; Bias; Burkina Faso - epidemiology; Community based health insurance; Community health services; Community Health Services - utilization; Demography; Design; Discrimination in medical care; Effectiveness; Epidemiology; Female; Financing, Personal - statistics & numerical data; Health care; Health insurance; Health services; Health Services Research; Health services utilization; Health surveillance; Households; Humans; Insurance, Health - economics; Insurance, Health - statistics & numerical data; Logistic Models; Male; Medical care; Medical research; Morbidity; Mortality - trends; National health insurance; Poisson Distribution; Population; Population Surveillance; Prenatal care; Primary care; Public health; Research centers; Rural Population - statistics & numerical data; Socioeconomic Factors; Studies; Surveillance; Surveillance equipment; Towns; Universal health coverage; Utilization; Burkina Faso
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-12-363

Financial barriers are a recognized major bottleneck of access and use of health services. The aim of this study was to assess effectiveness of a community based health insurance (CBHI) scheme on utilization of health services as well as on mortality and morbidity. Data were collected from April to December 2007 from the Nouna's Demographic Surveillance System on overall mortality, utilization of health services, household characteristics, distance to health facilities, membership in the Nouna CBHI. We analyzed differentials in overall mortality and selected maternal health process measures between members and non-members of the insurance scheme. After adjusting for covariates there was no significant difference in overall mortality between households who could not have been members (because their area was yet to be covered by the stepped-wedged scheme), non-members but whose households could have been members (areas covered but not enrolled), and members of the insurance scheme. The risk of overall mortality increased significantly with distance to health facility (35% more outside Nouna town) and with education level (37% lower when at least primary school education achieved in households). There was no statistically significant difference in overall mortality between members and non-members. The enrolment rates remain low, with selection bias. It is important that community based health insurances, exemptions fees policy and national health insurances be evaluated on prevention of deaths and severe morbidities instead of on drop-out rates, selection bias, adverse selection and catastrophic payments for health care only. Effective social protection will require national health insurance.