A systematic review of factors that affect uptake of community-based health insurance in low-income and middle income countries
Date
2015-12
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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.
Description
CITATION: Adebayo, E. F. et al. 2015. A systematic review of factors that affect uptake of community-based health insurance in low-income and middleincome countries. BMC Health Services Research, 15:543, doi:10.1186/s12913-015-1179-3.
The original publication is available at http://bmchealthservres.biomedcentral.com
The original publication is available at http://bmchealthservres.biomedcentral.com
Keywords
Community health services, Health insurance, Low-income consumers, Rural population, Health services accessibility
Citation
Adebayo, E. F. et al. 2015. A systematic review of factors that affect uptake of community-based health insurance in low-income and middleincome countries. BMC Health Services Research, 15:543, doi:10.1186/s12913-015-1179-3.