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Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal

Author

Listed:
  • Thomas Rouyard

    (HIAS Health - Research Center for Health Policy and Economics, Hitotsubashi University [Tokyo])

  • Yukichi Mano

    (Graduate School of Economics - Hitotsubashi University - Hitotsubashi University)

  • Bocar Mamadou Daff

    (UHC Senegal - National Agency for Universal Health Financial Protection, Dakar, Senegal)

  • Serigne Diouf

    (UHC Senegal - National Agency for Universal Health Financial Protection, Dakar, Senegal)

  • Khadidiatou Fall Dia

    (UHC Senegal - National Agency for Universal Health Financial Protection, Dakar, Senegal)

  • Laetitia Duval

    (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)

  • Josselin Thuilliez

    (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique, CNRS - Centre National de la Recherche Scientifique)

  • Ryota Nakamura

    (HIAS Health - Research Center for Health Policy and Economics, Hitotsubashi University [Tokyo])

Abstract

Community-based health insurance (CBHI) has been implemented in many low and middle-income countries to increase financial risk protection in populations without access to formal health insurance. While the design of such social programs is fundamental to ensuring equitable access to care, little is known about the operational and structural factors influencing enrolment in CBHI schemes. In this study, we took advantage of newly established data monitoring requirements in Senegal to explore the association between the operational capacity and structure of CBHI schemes—also termed ‘mutual health organisations' (MHO) in francophone countries—and their enrolment levels. The dataset comprised 12 waves of quarterly data over 2017–2019 and covered all 676 MHOs registered in the country. Primary analyses were conducted using dynamic panel data regression analysis. We found that higher operational capacity significantly predicted higher performance: enrolment was positively associated with the presence of a salaried manager at the MHO level (12% more total enrollees, 23% more poor members) and with stronger cooperation between MHOs and local health posts (for each additional contract signed, total enrollees and poor members increased by 7% and 5%, respectively). However, higher operational capacity was only modestly associated with higher sustainability proxied by the proportion of enrollees up to date with premium payment. We also found that structural factors were influential, with MHOs located within a health facility enrolling fewer poor members (−16%). Sensitivity analyses showed that these associations were robust. Our findings suggest that policies aimed at professionalising and reinforcing the operational capacity of MHOs could accelerate the expansion of CBHI coverage, including in the most impoverished populations. However, they also suggest that increasing operational capacity alone may be insufficient to make CBHI schemes sustainable over time.

Suggested Citation

  • 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," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-03641124, HAL.
    • Handle: RePEc:hal:cesptp:halshs-03641124
    DOI: 10.1093/heapol/czac033
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-03641124
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    1. Liran Einav & Jonathan Levin, 2014. "The Data Revolution and Economic Analysis," Innovation Policy and the Economy, University of Chicago Press, vol. 14(1), pages 1-24.
    2. Gauri, Varun, 2018. "eMBeDding for impact and scale in developing contexts," Behavioural Public Policy, Cambridge University Press, vol. 2(2), pages 256-262, November.
    3. Sebastian Kripfganz & Claudia Schwarz, 2019. "Estimation of linear dynamic panel data models with time‐invariant regressors," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 34(4), pages 526-546, June.
    4. David Mark Dror, 2018. "What Factors Affect Voluntary Uptake of Community-based Health Insurance Schemes in Lowand Middle-Income Countries? A Systematic Review and Meta-Analysis," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 14, pages 271-306, World Scientific Publishing Co. Pte. Ltd..
    5. Jacopo Bonanjacopo & Olivier Dagnelie & Philippe LeMay-Boucher & Michel Tenikue, 2017. "The Impact of Insurance Literacy and Marketing Treatments on the Demand for Health Microinsurance in Senegal: A Randomised Evaluation," Journal of African Economies, Centre for the Study of African Economies, vol. 26(2), pages 169-191.
    6. Chemouni, Benjamin, 2018. "The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda," World Development, Elsevier, vol. 106(C), pages 87-98.
    7. Hong Wang & Winnie Yip & Licheng Zhang & William C. Hsiao, 2009. "The impact of rural mutual health care on health status: evaluation of a social experiment in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 65-82, July.
    8. Gnawali, Devendra Prasad & Pokhrel, Subhash & Sié, Ali & Sanon, Mamadou & De Allegri, Manuela & Souares, Aurélia & Dong, Hengjin & Sauerborn, Rainer, 2009. "The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso," Health Policy, Elsevier, vol. 90(2-3), pages 214-222, May.
    9. 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.
    10. Hogarth, Robin M. & Soyer, Emre, 2015. "Communicating forecasts: The simplicity of simulated experience," Journal of Business Research, Elsevier, vol. 68(8), pages 1800-1809.
    11. Sebastian Kripfganz, 2019. "Generalized method of moments estimation of linear dynamic panel-data models," London Stata Conference 2019 17, Stata Users Group.
    12. Acharya, Arnab & Vellakkal, Sukumar & Taylor Fiona & Masset Edoardo & Satija, Ambika & Burke, Margaret & Ebrahim, Shah, 2013. "The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review," Policy Research Working Paper Series 6324, The World Bank.
    13. Jishnu Das & Alaka Holla & Aakash Mohpal & Karthik Muralidharan, 2016. "Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India," American Economic Review, American Economic Association, vol. 106(12), pages 3765-3799, December.
    14. Jishnu Das, 2011. "The Quality of Medical Care in Low-Income Countries: From Providers to Markets," PLOS Medicine, Public Library of Science, vol. 8(4), pages 1-2, April.
    15. 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.
    16. De Allegri, Manuela & Sanon, Mamadou & Sauerborn, Rainer, 2006. ""To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa," Social Science & Medicine, Elsevier, vol. 62(6), pages 1520-1527, March.
    17. 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.
    18. Criel, Bart & Waelkens, Maria Pia, 2003. "Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?," Social Science & Medicine, Elsevier, vol. 57(7), pages 1205-1219, October.
    19. Chemin, Matthieu, 2018. "Informal Groups and Health Insurance Take-up Evidence from a Field Experiment," World Development, Elsevier, vol. 101(C), pages 54-72.
    20. Schneider, Pia, 2005. "Trust in micro-health insurance: an exploratory study in Rwanda," Social Science & Medicine, Elsevier, vol. 61(7), pages 1430-1438, October.
    21. Jean Philippe Platteau & Darwin Ugarte Ontiveros, 2013. "Understanding and Information Failures in Insurance: Evidence from India," Development Research Working Paper Series 07/2013, Institute for Advanced Development Studies.
    22. Jean Philippe Platteau & Darwin Ugarte Ontiveros, 2013. "Understanding and Information Failures: Lessons from a Health Microinsurance Program in India," Working Papers 1301, University of Namur, Department of Economics.
    23. Mundlak, Yair, 1978. "On the Pooling of Time Series and Cross Section Data," Econometrica, Econometric Society, vol. 46(1), pages 69-85, January.
    24. 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.
    25. 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.
    26. Basaza, Robert & Criel, Bart & Van der Stuyft, Patrick, 2008. "Community health insurance in Uganda: Why does enrolment remain low? A view from beneath," Health Policy, Elsevier, vol. 87(2), pages 172-184, August.
    27. 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.
    28. Manuel Arellano & Stephen Bond, 1991. "Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 58(2), pages 277-297.
    29. Dong, Hengjin & De Allegri, Manuela & Gnawali, Devendra & Souares, Aurélia & Sauerborn, Rainer, 2009. "Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso," Health Policy, Elsevier, vol. 92(2-3), pages 174-179, October.
    30. Arnab Acharya & Sukumar Vellakkal & Fiona Taylor & Edoardo Masset & Ambika Satija & Margaret Burke & Shah Ebrahim, 2013. "The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review," The World Bank Research Observer, World Bank, vol. 28(2), pages 236-266, August.
    31. Platteau, Jean-Philippe & Ugarte Ontiveros, Darwin, 2021. "Cognitive bias in insurance: Evidence from a health scheme in India," World Development, Elsevier, vol. 144(C).
    32. 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.
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