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. 2015 Dec 8:15:543.
doi: 10.1186/s12913-015-1179-3.

A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries

Esther F Adebayo  1   2 , Olalekan A Uthman  3   4   5 , Charles S Wiysonge  6   7 , Erin A Stern  8 , Kim T Lamont  9 , John E Ataguba  10
Affiliations

A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries

Esther F Adebayo et al. BMC Health Serv Res. .

Abstract

Background: Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs.

Methods: We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review.

Results: Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment.

Conclusion: In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers' access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.

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Figures

Fig. 1
Fig. 1
Flow chart showing the results of search and selection of studies
Fig. 2
Fig. 2
Summary results from included studies
See this image and copyright information in PMC

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