Community-Based Health Insurance Schemes: A Systematic Review

Anagaw Derseh Mebratie, Robert Sparrow, Getnet Alemu, Arjun S. Bedi

Research output: Working paperAcademic

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Abstract

Due to the limited ability of publicly financed health systems in developing countries to provide adequate access to health care, community-based health financing has been proposed as a viable option. This has led to the implementation of a number of Community- Based Health Insurance (CBHI) schemes, in several developing countries. To assess the ability of such schemes in meeting their stated objectives, this study systematically reviews the existing empirical evidence on three outcomes – access to schemes, effect on health care utilization and effect on financial protection. In addition to collating and summarizing the evidence we analyse the link between key scheme design characteristics and their effect on outcomes and comment on the role that may be played by study characteristics in influencing outcomes. The review shows that the ultra-poor are often excluded and at the same time there is evidence of adverse selection. The bulk of the studies find that access to CBHI is associated with increased health care utilization, especially with regard to the use of relatively cheaper outpatient care services as opposed to inpatient care. The schemes also appear to mitigate catastrophic healthcare expenditure. There are clear links between scheme design and effectiveness suggesting the importance of involving the target population in designing and implementing CBHI schemes.
Original languageEnglish
Place of PublicationThe Hague
PublisherInternational Institute of Social Studies (ISS)
Number of pages47
Publication statusPublished - Oct 2013

Publication series

SeriesISS working papers. General series
Number568
ISSN0921-0210

Bibliographical note

hdl.handle.net/1765/50087

Research programs

  • EUR-ISS-EDEM
  • EUR-ISS-SGI

Series

  • ISS Working Paper-General Series

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