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Community based health insurance schemes in Africa: The case of Rwanda

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  • Shimeles, Abebe

    ()
    (Development Research Department African Development Bank)

Abstract

Community-based health insurance schemes (Mutuelles) in Rwanda are one of the largest experiments in community based risk-sharing mechanisms in Sub-Saharan Africa for health related problems. This study examines the impact of the program on demand for modern health care, mitigation of out-of-pocket catastrophic health expenditure and social inclusiveness based on a nationally representative household survey using traditional regression approach and matching estimator popular in the evaluation literature. Our findings suggest that Mutuelles have been successful in increasing utilization of modern health care services and reducing catastrophic health related expenditure. According to our preferred method, higher utilization of health care services was found among the insured non-poor than insured poor households, with comparable effect in reducing health-related expenditure shocks. This reinforces the inequity already inherent in the Mutuelles system.

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File URL: http://hdl.handle.net/2077/23064
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Bibliographic Info

Paper provided by University of Gothenburg, Department of Economics in its series Working Papers in Economics with number 463.

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Length: 23 pages
Date of creation: 06 Aug 2010
Date of revision:
Handle: RePEc:hhs:gunwpe:0463

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Postal: Department of Economics, School of Business, Economics and Law, University of Gothenburg, Box 640, SE 405 30 GÖTEBORG, Sweden
Phone: 031-773 10 00
Web page: http://www.handels.gu.se/econ/
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Related research

Keywords: demand for health services; catastrophic health expenditure; average treatment effects; endogenous dummy variable; matching estimator;

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References

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  1. Guido W. Imbens, 2010. "Better LATE Than Nothing: Some Comments on Deaton (2009) and Heckman and Urzua (2009)," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 399-423, June.
  2. Alberto Abadie & Guido W. Imbens, 2006. "Large Sample Properties of Matching Estimators for Average Treatment Effects," Econometrica, Econometric Society, Econometric Society, vol. 74(1), pages 235-267, 01.
  3. Heckman, James J, 1978. "Dummy Endogenous Variables in a Simultaneous Equation System," Econometrica, Econometric Society, Econometric Society, vol. 46(4), pages 931-59, July.
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Cited by:
  1. Mebratie, A.D. & Sparrow, R.A. & Alemu, G. & Bedi, A.S., 2013. "Community-Based Health Insurance Schemes," ISS Working Papers - General Series, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague 568, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
  2. BONAN Jacopo & LEMAY-BOUCHER Philippe & TENIKUE Michel, 2013. "Household's willingness to pay for health microinsurance and its impact on actual take-up: results from a field experiment in Senegal," CEPS/INSTEAD Working Paper Series 2013-15, CEPS/INSTEAD.
  3. Binagwaho, Agnes & Hartwig, Renate & Ingeri, Denyse & Makaka, Andrew, 2012. "Mutual health insurance and its contribution to improving child health in Rwanda," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-66-12, University of Passau, Faculty of Business and Economics.
  4. Léonce Ndikumana, 2013. "Overcoming Low Political Equilibrium in Africa: Institutional Changes for Inclusive Development," Working Papers, Political Economy Research Institute, University of Massachusetts at Amherst wp331, Political Economy Research Institute, University of Massachusetts at Amherst.
  5. Ncube, Mthuli & Brixiova, Zuzana & Bicaba, Zorobabel, 2014. "Can Dreams Come True? Eliminating Extreme Poverty in Africa by 2030," IZA Discussion Papers 8120, Institute for the Study of Labor (IZA).
  6. Derseh, A. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2013. "Enrolment in Ethiopia’s Community Based Health Insurance Scheme," ISS Working Papers - General Series, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague 578, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.

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