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Design, implementation, and evaluation of a community financing scheme for hospital care in developing countries: A pre-paid health plan in the Bwamanda health zone, Zaire


  • Moens, Freddy


Unless scarce resources can be mobilized and used efficiently, health for all by the year 2000 will remain a vain attempt. Innovative financing schemes exploring increased cost recovery from the users of the health system are explored throughout the world. In Bwamanda, Zaire, a community financing scheme for hospital care was developed through the application of operations research. A preference heuristic with considerable involvement of health providers and the community was used to identify the type of financing scheme and resulted in a pre-paid health plan, while a mathematical model was developed to determine the premiums to charge. The implementation of the health plant is briefly described. An evaluation of the effects of the pre-paid plan on the accessibility and equity of health care, as well as on the financial sustainability of the hospital, is presented and discussed: a steadily increasing membership of the health plan illustrates its appropriateness, while a doubling of the cost recovery of the hospital's operating costs after two years seems promising; the hospitalization rate of members of the health plan was significantly higher than for non-members. These findings suggest that a health zone may be an appropriate level for the organization of a regional pre-paid health plan. Problems of equity, full cost recovery, and replicability of the financing scheme are discussed.

Suggested Citation

  • Moens, Freddy, 1990. "Design, implementation, and evaluation of a community financing scheme for hospital care in developing countries: A pre-paid health plan in the Bwamanda health zone, Zaire," Social Science & Medicine, Elsevier, vol. 30(12), pages 1319-1327, January.
  • Handle: RePEc:eee:socmed:v:30:y:1990:i:12:p:1319-1327

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    Cited by:

    1. Habtom, GebreMichael Kibreab & Ruys, Pieter, 2007. "Traditional risk-sharing arrangements and informal social insurance in Eritrea," Health Policy, Elsevier, vol. 80(1), pages 218-235, January.
    2. Habtom, G., 2006. "Health Care Governance in Developing Countries : The Case of Eritrea," Other publications TiSEM 289e6243-bb73-4d66-a6a1-8, Tilburg University, School of Economics and Management.
    3. De Allegri, Manuela & Sanon, Mamadou & Bridges, John & Sauerborn, Rainer, 2006. "Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa," Health Policy, Elsevier, vol. 76(1), pages 58-71, March.


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