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Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro‐health insurance and user fees in Rwanda

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  • Pia Schneider
  • Kara Hanson

Abstract

This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out‐of‐pocket health spending contributed to increased poverty. The analysis uses cross‐sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community‐based health insurance. Results indicate that health spending had a small impact on the socio‐economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user‐fee paying individuals who reported significantly lower visit rates than the insured. Copyright © 2005 John Wiley & Sons, Ltd.

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  • Pia Schneider & Kara Hanson, 2006. "Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro‐health insurance and user fees in Rwanda," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 19-31, January.
  • Handle: RePEc:wly:hlthec:v:15:y:2006:i:1:p:19-31
    DOI: 10.1002/hec.1014
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    1. Bornemisza, Olga & Ranson, M. Kent & Poletti, Timothy M. & Sondorp, Egbert, 2010. "Promoting health equity in conflict-affected fragile states," Social Science & Medicine, Elsevier, vol. 70(1), pages 80-88, January.
    2. Rama Joglekar, 2008. "Can Insurance Reduce Catastrophic Out-of-Pocket Health Expenditure?," Labor Economics Working Papers 22367, East Asian Bureau of Economic Research.
    3. Robyn, Paul Jacob & Fink, Günther & Sié, Ali & Sauerborn, Rainer, 2012. "Health insurance and health-seeking behavior: Evidence from a randomized community-based insurance rollout in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 75(4), pages 595-603.
    4. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    5. Ali, Shehzad & Cookson, Richard & Dusheiko, Mark, 2017. "Addressing care-seeking as well as insurance-seeking selection biases in estimating the impact of health insurance on out-of-pocket expenditure," Social Science & Medicine, Elsevier, vol. 177(C), pages 127-140.
    6. Witter, Sophie, 2012. "Health financing in fragile and post-conflict states: What do we know and what are the gaps?," Social Science & Medicine, Elsevier, vol. 75(12), pages 2370-2377.
    7. Kai Liu & Benjamin Cook & Chunling Lu, 2019. "Health inequality and community-based health insurance: a case study of rural Rwanda with repeated cross-sectional data," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(1), pages 7-14, January.
    8. Saksena, Priyanka & Antunes, Adélio Fernandes & Xu, Ke & Musango, Laurent & Carrin, Guy, 2011. "Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection," Health Policy, Elsevier, vol. 99(3), pages 203-209, March.
    9. Parmar, Divya & Souares, Aurélia & de Allegri, Manuela & Savadogo, Germain & Sauerborn, Rainer, 2012. "Adverse selection in a community-based health insurance scheme in rural Africa: implications for introducing targeted subsidies," LSE Research Online Documents on Economics 46664, London School of Economics and Political Science, LSE Library.
    10. Slim Haddad & Valery Ridde & Ismaelou Yacoubou & Geneviève Mák & Michel Gbetié, 2012. "An Evaluation of the Outcomes of Mutual Health Organizations in Benin," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-8, October.
    11. Nikolaos Grigorakis & Christos Floros & Haritini Tsangari & Evangelos Tsoukatos, 2017. "Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 261-287, September.
    12. Dekker, Marleen & Wilms, Annegien, 2010. "Health Insurance and Other Risk-Coping Strategies in Uganda: The Case of Microcare Insurance Ltd," World Development, Elsevier, vol. 38(3), pages 369-378, March.
    13. Chunling Lu & Brian Chin & Jiwon Lee Lewandowski & Paulin Basinga & Lisa R Hirschhorn & Kenneth Hill & Megan Murray & Agnes Binagwaho, 2012. "Towards Universal Health Coverage: An Evaluation of Rwanda Mutuelles in Its First Eight Years," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-16, June.
    14. 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.
    15. Smith, Kimberly V. & Sulzbach, Sara, 2008. "Community-based health insurance and access to maternal health services: Evidence from three West African countries," Social Science & Medicine, Elsevier, vol. 66(12), pages 2460-2473, June.

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