IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v371y2025ics0277953625001996.html
   My bibliography  Save this article

Comprehensive assessment of the impact of mandatory community-based health insurance in Burkina Faso

Author

Listed:
  • Boutin, Delphine
  • Petitfour, Laurène
  • Allard, Yvonne
  • Kountoubré, Souleymane
  • Ridde, Valéry

Abstract

Health coverage for informal workers in Sub-Saharan Africa remains a major challenge. This study evaluates an alternative approach: bundling health insurance with microcredit. We conducted a randomized controlled trial in Ouagadougou, Burkina Faso, to assess the impact of mandatory health insurance linked to microcredit. The study covered 88 microcredit groups (44 treated, 44 control), analyzing outcomes for 1,095 individuals who reported illness episodes in the six months preceding the final survey in January–February 2022. Results show that the insurance requirement did not lead to program dropout, with loan renewal rates remaining stable between groups. Health insurance had a significant positive impact on financial protection: out-of-pocket expenses decreased by over 50% and payment difficulties by 36%. The study also reveals changes in health-seeking behaviors. Use of modern healthcare facilities increased by 7%, while reliance on traditional medicine decreased by 61%. Insured individuals also sought care more quickly, with 23% more seeking care on the same day symptoms appeared. However, no significant impact was observed on physical or psychological health outcomes. These findings suggest that bundling health insurance with other services like microcredit can be a viable solution for deploying mandatory health coverage to populations working in the informal sector. This approach provides significant financial protection against health risks and improves access to healthcare.

Suggested Citation

  • Boutin, Delphine & Petitfour, Laurène & Allard, Yvonne & Kountoubré, Souleymane & Ridde, Valéry, 2025. "Comprehensive assessment of the impact of mandatory community-based health insurance in Burkina Faso," Social Science & Medicine, Elsevier, vol. 371(C).
    • Handle: RePEc:eee:socmed:v:371:y:2025:i:c:s0277953625001996
    DOI: 10.1016/j.socscimed.2025.117870
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625001996
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2025.117870?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Yoav Benjamini & Abba M. Krieger & Daniel Yekutieli, 2006. "Adaptive linear step-up procedures that control the false discovery rate," Biometrika, Biometrika Trust, vol. 93(3), pages 491-507, September.
    2. Powell-Jackson, Timothy & Hanson, Kara & Whitty, Christopher J.M. & Ansah, Evelyn K., 2014. "Who benefits from free healthcare? Evidence from a randomized experiment in Ghana," Journal of Development Economics, Elsevier, vol. 107(C), pages 305-319.
    3. Capuno, Joseph J. & Kraft, Aleli D. & Poco, Louisa Camille & Quimbo, Stella A. & Tan, Carlos Antonio R., 2019. "Health conditions, payments, proximity, and opportunity costs: Examining delays in seeking inpatient and outpatient care in the Philippines," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    4. Jishnu Das & Quy-Toan Do, 2023. "The Prices in the Crises: What We Are Learning from 20 Years of Health Insurance in Low- and Middle-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 37(2), pages 123-152, Spring.
    5. Haushofer, Johannes & Chemin, Matthieu & Jang, Chaning & Abraham, Justin, 2020. "Economic and psychological effects of health insurance and cash transfers: Evidence from a randomized experiment in Kenya," Journal of Development Economics, Elsevier, vol. 144(C).
    6. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance?: findings from an exploratory household survey in Senegal," LSE Research Online Documents on Economics 55820, London School of Economics and Political Science, LSE Library.
    7. Nyman, John A. & Koc, Cagatay & Dowd, Bryan E. & McCreedy, Ellen & Trenz, Helen Markelova, 2018. "Decomposition of moral hazard," Journal of Health Economics, Elsevier, vol. 57(C), pages 168-178.
    8. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2015. "Impact of Ethiopia's Community Based Health Insurance on Household Economic Welfare," The World Bank Economic Review, World Bank, vol. 29(suppl_1), pages 164-173.
    9. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
    10. Rabbani, Atonu & Mehareen, Jeenat & Chowdhury, Imran Ahmed & Sarker, Malabika, 2022. "Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment," Social Science & Medicine, Elsevier, vol. 292(C).
    11. Wameq A. Raza & Ellen van de Poel & Arjun Bedi & Frans Rutten, 2016. "Impact of Community‐based Health Insurance on Access and Financial Protection: Evidence from Three Randomized Control Trials in Rural India," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 675-687, June.
    12. Valéry Ridde & Pierre Yaméogo, 2018. "How Burkina Faso used evidence in deciding to launch its policy of free healthcare for children under five and women in 2016," Palgrave Communications, Palgrave Macmillan, vol. 4(1), pages 1-9, December.
    13. Li, Yao & Li, Lei & Liu, Junxia, 2023. "The efficient moral hazard effect of health insurance: Evidence from the consolidation of urban and rural resident health insurance in China," Social Science & Medicine, Elsevier, vol. 324(C).
    14. Shigute, Zemzem & Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2017. "Uptake of health insurance and the productive safety net program in rural Ethiopia," Social Science & Medicine, Elsevier, vol. 176(C), pages 133-141.
    15. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Abebaw, Degnet & Alemu, Getnet & Bedi, Arjun S., 2019. "The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care," Social Science & Medicine, Elsevier, vol. 220(C), pages 112-119.
    16. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal," Social Science & Medicine, Elsevier, vol. 107(C), pages 78-88.
    17. Agier, Isabelle & Ly, Antarou & Kadio, Kadidiatou & Kouanda, Seni & Ridde, Valéry, 2016. "Endorsement of universal health coverage financial principles in Burkina Faso," Social Science & Medicine, Elsevier, vol. 151(C), pages 157-166.
    18. Abhijit Banerjee & Esther Duflo & Richard Hornbeck, 2014. "Bundling Health Insurance and Microfinance in India: There Cannot Be Adverse Selection If There Is No Demand," American Economic Review, American Economic Association, vol. 104(5), pages 291-297, May.
    19. Bialowolski, Piotr & Weziak-Bialowolska, Dorota & Lee, Matthew T. & Chen, Ying & VanderWeele, Tyler J. & McNeely, Eileen, 2021. "The role of financial conditions for physical and mental health. Evidence from a longitudinal survey and insurance claims data," Social Science & Medicine, Elsevier, vol. 281(C).
    20. Platteau, Jean-Philippe & De Bock, Ombeline & Gelade, Wouter, 2017. "The Demand for Microinsurance: A Literature Review," World Development, Elsevier, vol. 94(C), pages 139-156.
    21. Kuwawenaruwa, August & Ramsey, Kate & Binyaruka, Peter & Baraka, Jitihada & Manzi, Fatuma & Borghi, Josephine, 2019. "Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation," Social Science & Medicine, Elsevier, vol. 225(C), pages 17-25.
    22. Levine, David & Polimeni, Rachel & Ramage, Ian, 2016. "Insuring health or insuring wealth? An experimental evaluation of health insurance in rural Cambodia," Journal of Development Economics, Elsevier, vol. 119(C), pages 1-15.
    23. Abhijit Banerjee & Amy Finkelstein & Rema Hanna & Benjamin A. Olken & Arianna Ornaghi & Sudarno Sumarto, 2021. "The Challenges of Universal Health Insurance in Developing Countries: Experimental Evidence from Indonesia's National Health Insurance," American Economic Review, American Economic Association, vol. 111(9), pages 3035-3063, September.
    24. Wood, Anna, 2023. "Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal," Social Science & Medicine, Elsevier, vol. 319(C).
    25. Platteau, Jean-Philippe & Ugarte Ontiveros, Darwin, 2021. "Cognitive bias in insurance: Evidence from a health scheme in India," World Development, Elsevier, vol. 144(C).
    26. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2019. "Can information increase the understanding and uptake of insurance? Lessons from a randomized experiment in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 220(C), pages 102-111.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Boutin, Delphine & Petifour, Laurene & Allard, Yvonne & Kontoubré, Souleymane & Ridde, Valéry, 2024. "Comprehensive Assessment of the Impact of Mandatory Community-Based Health Insurance in Burkina Faso," IZA Discussion Papers 17094, Institute of Labor Economics (IZA).
    2. Rabbani, Atonu & Mehareen, Jeenat & Chowdhury, Imran Ahmed & Sarker, Malabika, 2022. "Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment," Social Science & Medicine, Elsevier, vol. 292(C).
    3. Thomas Rouyard & Yukichi Mano & Bocar Mamadou Daff & Serigne Diouf & Khadidiatou Fall Dia & Laetitia Duval & Josselin Thuilliez & Ryota Nakamura, 2022. "Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal," Post-Print halshs-03641124, HAL.
    4. Das,Jishnu & Do,Quy-Toan, 2023. "The Prices in the Crises : What We Are Learning from Twenty Years of Health Insurance inLow- and Middle-Income Countries," Policy Research Working Paper Series 10313, The World Bank.
    5. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2019. "Can information increase the understanding and uptake of insurance? Lessons from a randomized experiment in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 220(C), pages 102-111.
    6. Malani, Anup & Holtzman, Phoebe & Imai, Kosuke & Kinnan, Cynthia & Miller, Morgen & Swaminathan, Shailender & Voena, Alessandra & Woda, Bartek & Conti, Gabriella, 2021. "Effect of Health Insurance in India: A Randomized Controlled Trial," IZA Discussion Papers 14913, Institute of Labor Economics (IZA).
    7. Baillon, Aurélien & Capuno, Joseph & O'Donnell, Owen & Tan, Carlos Antonio & van Wilgenburg, Kim, 2022. "Persistent effects of temporary incentives: Evidence from a nationwide health insurance experiment," Journal of Health Economics, Elsevier, vol. 81(C).
    8. Anup Malani & Cynthia Kinnan & Gabriella Conti & Kosuke Imai & Morgen Miller & Shailender Swaminathan & Alessandra Voena & Bartosz Woda, 2024. "Evaluating pricing health insurance in lower-income countries: A field experiment in India," IFS Working Papers W24/33, Institute for Fiscal Studies.
    9. Hirvonen, Kalle & Bossuyt, Anne & Pigois, Remy, 2017. "Complementarities between social protection and health sector policies: Evidence from the Productive Safety Net Program in Ethiopia," ESSP working papers 112, International Food Policy Research Institute (IFPRI).
    10. Nshakira-Rukundo, Emmanuel & Mussa, Essa Chanie & Gerber, Nicolas & von Braun, Joachim, 2020. "Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda," Social Science & Medicine, Elsevier, vol. 245(C).
    11. Malani, Anup & Kinnan, Cynthia & Conti, Gabriella & Imai, Kosuke & Miller, Morgen & Swaminathan, Shailender & Voena, Alessandra & Woda, Bartek, 2024. "Evaluating and pricing health insurance in lower-income countries: A field experiment in India," CEPR Discussion Papers 19326, C.E.P.R. Discussion Papers.
    12. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    13. Mussa, Essa Chanie & Otchere, Frank & Vinci, Vincenzo & Reshad, Abduljelil & Palermo, Tia, 2021. "Linking poverty-targeted social protection and Community Based Health Insurance in Ethiopia: Enrolment, linkages, and gaps," Social Science & Medicine, Elsevier, vol. 286(C).
    14. Emily Gustafsson-Wright & Gosia Popławska & Zlata Tanović & Jacques Gaag, 2018. "The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 221-276, September.
    15. Nathanael Ojong, 2019. "Healthcare Financing in Rural Cameroon," Societies, MDPI, vol. 9(4), pages 1-12, November.
    16. Shigute, Zemzem & Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2017. "Uptake of health insurance and the productive safety net program in rural Ethiopia," Social Science & Medicine, Elsevier, vol. 176(C), pages 133-141.
    17. Xiaoqi Zhang & Yi Chen & Yi Yao, 2021. "Dynamic information asymmetry in micro health insurance: implications for sustainability," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 46(3), pages 468-507, July.
    18. Aurélien Baillon & Aleli Kraft & Owen O’Donnell & Kim Wilgenburg, 2022. "A behavioral decomposition of willingness to pay for health insurance," Journal of Risk and Uncertainty, Springer, vol. 64(1), pages 43-87, February.
    19. Lau, Siew Yee & Parinduri, Rasyad & Lee, Yoong Hon, 2019. "Does Social Health Insurance Help Owners of Micro- and Small Firms Cope with Family Hardships? Evidence from Indonesia," MPRA Paper 95295, University Library of Munich, Germany.
    20. Menghan Shen & Zhiwei Tang & Xiaoxia Liang & Xiaoyang Ye, 2025. "Migrant children's take‐up of social health insurance: Experimental evidence from China," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 44(2), pages 456-482, March.

    More about this item

    Keywords

    Health insurance; Financial protection; Healthcare utilization; Informal sector; Burkina Faso;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • G21 - Financial Economics - - Financial Institutions and Services - - - Banks; Other Depository Institutions; Micro Finance Institutions; Mortgages
    • O55 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Africa

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:371:y:2025:i:c:s0277953625001996. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.