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A prepayment scheme for hospital care in the Masisi district in Zaire: A critical evaluation

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  • Noterman, Jean-Pierre
  • Criel, Bart
  • Kegels, Guy
  • Isu, Katulanya

Abstract

In most developing countries, government funding allocated to the health services is not sufficient to allow these services to provide appropriate health care accessible to all. Consequently, community financing has received much more attention in recent years and innovative schemes are being explored throughout the developing world. Risk-sharing schemes, like prepayment, are interesting because of their potential redistributive effects. At the end of the eighties, a prepayment scheme for hospital care was experimented with in the Masisi health district in Eastern Zaire. In the present paper, the experiment is described in a chronological way and the results are analyzed and discussed in detail. Although this particular case-study was not successful, it yields important lessons concerning the design, implementation and evaluation of prepayment schemes for hospital health care in developing countries. More specifically, phenomena like adverse selection and moral hazard are discussed. Finally, conditions for success of similar experiments are discussed. These conditions relate mainly to the organization pattern of the district health services system. The Masisi experiment is a nice illustration of the fact that prepayment is not a 'magic bullet': the lessons drawn from it may be of relevancy to health planners intending to implement hospital prepayment schemes in similar settings.

Suggested Citation

  • Noterman, Jean-Pierre & Criel, Bart & Kegels, Guy & Isu, Katulanya, 1995. "A prepayment scheme for hospital care in the Masisi district in Zaire: A critical evaluation," Social Science & Medicine, Elsevier, vol. 40(7), pages 919-930, April.
  • Handle: RePEc:eee:socmed:v:40:y:1995:i:7:p:919-930
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    Citations

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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 568, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    2. World Bank, 2005. "Democratic Republic of Congo : Health, Nutrition and Population, Country Status Report," World Bank Other Operational Studies 8771, The World Bank.
    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. Gonzalez Block, Miguel Angel, 1997. "Comparative research and analysis methods for shared learning from health system reforms," Health Policy, Elsevier, vol. 42(3), pages 187-209, December.
    5. 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.
    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. Stephen Kwasi Opoku Duku & Francis Asenso-Boadi & Edward Nketiah-Amponsah & Daniel Kojo Arhinful, 2016. "Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana," Health Economics Review, Springer, vol. 6(1), pages 1-12, December.

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