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The health card insurance scheme in Burundi: A social asset or a non-viable venture?


  • Arhin, Dyna C.


La Carte d'Assurance Maladie (CAM) is a national health card insurance scheme implemented by the government of Burundi since 1984. Focus group discussions, a household survey, and a retrospective outpatient survey were used in 1992 to assess its financial and social performance in Muyinga Province. The study showed that although the revenue from premiums was insufficient to fund even the recurrent costs of outpatient drugs consumed by participating households (the current price of the CAM card would cover approx. 34% of the outpatient drug costs), the scheme performed a valuable social equity function. Women reported that they had little access to cash and that CAM, by eliminating cash payments at the point of use, empowered them to decide the need for, and timing of, health care consumption by household members without consulting male household heads. Other findings suggested that the schemes financial performance was poor because current membership was low (23% of households) and, more importantly, households with relatively high risks dominated the scheme ('adverse household selection'), making risk-sharing sub-optimal. The author concludes that improvements in the quality of care, in particular increased drug availability and higher standards of prescribing by health workers, would encourage the participation of 'lower risk' households, many of whom did not have a valid CAM because they judged the quality of care provided under the scheme to be inadequate. A policy obliging communes (local governments) to use the greater part of the scheme's revenue, initially supplemented by external 'seed money', to fund services at the health centres would facilitate these improvements. It is envisaged that improved quality would also lead to increased revenue and therefore, greater financial viability, by paving the way for moderate increases in the price of the card.

Suggested Citation

  • Arhin, Dyna C., 1994. "The health card insurance scheme in Burundi: A social asset or a non-viable venture?," Social Science & Medicine, Elsevier, vol. 39(6), pages 861-870, September.
  • Handle: RePEc:eee:socmed:v:39:y:1994:i:6:p:861-870

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    Cited by:

    1. Gilson, Lucy & Mills, Anne, 1995. "Health sector reforms in sub-Saharan Africa: lessons of the last 10 years," Health Policy, Elsevier, vol. 32(1-3), pages 215-243.
    2. Dr B C Purohit, "undated". "Structural Adjustment and the Health Care Sector in India: some policy issues in financing," QEH Working Papers qehwps02, Queen Elizabeth House, University of Oxford.
    3. Wang, Hong & Zhang, Licheng & Yip, Winnie & Hsiao, William, 2006. "Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China," Social Science & Medicine, Elsevier, vol. 63(5), pages 1236-1245, September.
    4. Zhang, Licheng & Wang, Hong, 2008. "Dynamic process of adverse selection: Evidence from a subsidized community-based health insurance in rural China," Social Science & Medicine, Elsevier, vol. 67(7), pages 1173-1182, October.
    5. Sahoo, Amit Kumar & Madheswaran, S., 2014. "Out of pocket (OOP) financial risk protection: The role of health insurence," Working Papers 330, Institute for Social and Economic Change, Bangalore.
    6. Masahide Kondo & Barbara McPake, 2007. "Making choices between prepayment and user charges in Zambia. What are the results for equity?," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1371-1387.
    7. Hentschel, Jesko, 1998. "Distinguishing between types of data and methods of collecting them," Policy Research Working Paper Series 1914, The World Bank.
    8. Ntimarubusa, Frederic, 2015. "La construction d’un socle de protection sociale au Burundi," IOB Discussion Papers 2015.02, Universiteit Antwerpen, Institute of Development Policy (IOB).


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