Publication: The Impact of Health Insurance on the Access to Health Care and Financial Protection in Rural Developing Countries : The Example of Senegal
Loading...
Published
2001-09
ISSN
Date
2013-06-05
Author(s)
Editor(s)
Abstract
Community-based health insurance schemes are becoming increasingly recognized as an instrument to finance health care in developing countries. Taking the example of "les mutuelles de santes" (mutual health organization) in rural Senegal this paper analyzes whether or not members in a mutual health insurance scheme have better access to health care than nonmembers. A binary probit model is estimated for the determinants of participation in a mutual and a logit/log linear model is used to measure the impact on health care utilization and financial protection. The results show that, while the health insurance schemes reach otherwise excluded people, the very poorest in the communities are not covered. Regarding the impact on the access to health care, members have a higher probability of using hospitalization services than nonmembers and pay substantially less when they need care. Given the results of this study, community financing schemes have the potential to improve the risk-management capacity of rural households. To reduce identified limitations of the schemes, an enlargement of the risk pool and a scaling up or linking of the schemes is, however, a prerequisite. Appropriate instruments to be further tested should include reinsurance policies, subsidies for the poorest and developing linkages to the private sector via the promotion of group insurance policies. All these instruments call for a stronger role of public health policy.
Link to Data Set
Citation
“Jutting, Johannes Paul. 2001. The Impact of Health Insurance on the Access to Health Care and Financial Protection in Rural Developing Countries : The Example of Senegal. HNP discussion paper series;. © World Bank. http://hdl.handle.net/10986/13774 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Social Inclusion and Financial Protection through Community Financing : Initial Results from Five Household Surveys(World Bank, Washington, DC, 2001-09)This paper provides empirical evidence regarding the performance of community-based health care financing in terms of (a) social inclusion and (b) financial protection. Five non-standardized household surveys were analyzed from India (two samples), Senegal, Rwanda, and Thailand. Common methodology was applied to the five data sets. Logistic regression was used to estimate the determinants of enrolling in a community financing scheme. A two-part model was used to assess the determinants of financial protection: part one used logistic regression to estimate the determinants of the likelihood of visiting a health care provider; part two used ordinary least-squares regression to estimate the determinants of out-of-pocket payments. The research finds: (a) Social inclusion. The findings suggest that community financing can be inclusive of the poorest even in the most economically deprived context. Nevertheless, this targeting outcome is not automatically attributable to the involvement of the community; rather it depends on key design and implementation characteristics of the schemes. (b) Financial protection. Community financing reduces financial barriers to health care as demonstrated by higher utilization and simultaneously lower out-of-pocket expenditure of scheme members controlling for a range of socioeconomic variables. The paper concludes: (a) Social inclusion. Design and implementation characteristics of community financing schemes matter to achieve good targeting outcome-community involvement alone does not guarantee social inclusion. Further research is needed to delineate which design and implementation characteristics allow better inclusion of the poor. (b) Financial protection. Prepayment and risk sharing, even on a small scale, reduce financial access barriers.Publication Community Involvement in Health Care Financing : A Survey of the Literature on the Impact, Strengths, and Weaknesses(World Bank, Washington, DC, 2001-09)The paper reviews 45 published and unpublished reports on community financing completed between 1990 and 2001. The main objective of the study was to explore performance measures reported in the literature regarding community financing. The study concluded that the reviewed literature is rich in describing scheme design and implementation. At the same time, evidence on the performance of community financing schemes is limited. The study focused on reporting measures on three indicators in particular: Resource mobilization capacity. Community financing mechanisms mobilize significant resources for health care. However, there is a large variation in the resource mobilization capacity of various schemes. This review did not find systematic estimates about how much community financing contributes to health revenues at the local and/or national level. Social inclusion. Community financing is effective in reaching a large number of low-income populations who would otherwise have no financial protection against the cost of illness. There is large variation in the size of various schemes. At the same time, there are no estimates about the total population covered through community financing. There are indications that the poorest and socially excluded groups are not automatically reached by community financing initiatives. Financial protection. Community-based health financing schemes are systematically reported to reduce the out-of-pocket spending of their members while increasing their utilization of health care services.Publication Actuarial Costing of Universal Health Insurance and Coverage in Indonesia(World Bank, Washington, DC, 2011-04)This series is produced by the Health, Nutrition, and Population family (HNP) of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.Publication Health Financing Reform in Thailand : Toward Universal Coverage under Fiscal Constraints(World Bank,Washington DC, 2013-01)Thailand's model of health financing and its ability to rapidly expand health insurance coverage to its entire population presents an interesting case study. Even though it is still a middle-income country with limited fiscal resources, the country managed to reach universal health insurance coverage through three main public schemes: the Universal Coverage Scheme (UCS), the Social Security Scheme (SSS), and the Civil Servant Medical Benefit Scheme (CSMBS). The UCS, which is the largest and most instrumental scheme in the expansion of coverage to the poor and to those in the informal sector, is the focus of this report. It describes the nuts and bolts of the UCS as a key component of the health financing system in Thailand. It analyzes Thailand's experience in health insurance coverage expansion within limited fiscal constraints through various mechanisms to contain costs. It also explores the two commonly discussed approaches for the universal coverage movement: the expansion model (starting from covering the poor and formal sector to universal coverage) and the comprehensive approach (covering the entire population at the same time).Publication Evidence on Cost-sharing in Health Care : Applications to Hungary : Executive Summary(Washington, DC, 2008-02-15)This study, done at the request of the Hungarian government, presents evidence on cost-sharing in the health sector, and its application in Hungary. It presents results on the impact of cost-sharing on revenues in health facilities and insurance, financial sustainability, informal payments, overall service use, and equity in access. Five keyfindings emerge: cost-sharing could lead to a reduction in unnecessary care provided to insured patients who do not have to pay the full price of care; cost-sharing could help reduce informal payments and keep patient payments in the system; cost-sharing with exemption policies are a prerequisite to provide equity in access to care; cost-sharing could support cost containment strategies; experience from OECD countries provides examples of successful cost-sharing policies. Based on these findings. the study recommends that Hungary continues to monitor and evaluate the impact of cost-sharing on access, to identify possible negative effects on equity in service use. In Hungary, financial incentives through the provider payment system could eventually support the effect of the government supply-side strategy. Such financial incentives could be set to providers through capitation payment to reward better quality of care, and Diagnosis Related Group (DRG) payments with expenditure ceilings with strict utilization review and quality assurance control to set an incentive for efficient provision of care.
Users also downloaded
Showing related downloaded files
Publication Conducting Classroom Observations(World Bank, Washington, DC, 2017-07)The “Stallings Classroom Snapshot” instrument, technically called the “Stanford Research Institute Classroom Observation System”, was developed by Professor Jane Stallings for research on the efficiency and quality of basic education teachers in the United States in the 1970s. (Stallings, 1977; Stallings and Mohlman, 1988). The Stallings instrument generates robust quantitative data on the interaction of teachers and students in the classroom, with a high degree of inter-rater reliability (0.8 or higher) among observers with relatively limited training, which makes it suitable for large-scale samples in developing country settings. (Jukes, 2006; Abadzi, 2007; DeStefano et al, 2010; Schuh-Moore et al, 2010). The instrument is language and curriculum-neutral, so results are directly comparable across different types of schools and country contexts, and a growing body of comparative country data from the US and developing countries is available. Use of the Stallings classroom snapshot in more than seven countries in the Latin America and the Caribbean region in recent years has generated a global data base of more than 20,000 different classroom observations in more than 3,600 schools. A public use online database is being created on the World Bank/SIEF (Strategic Impact Evaluation Fund) website. These data provide valuable reference benchmarks for any country or education system that uses the Stallings instrument following the protocol outlined in this guide.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication IFC Annual Report 2011 : I Am Opportunity(Washington, DC: World Bank, 2011)This annual report of the IFC reviews the years accomplishments. IFC, a member of the World Bank Group, is the largest global development institution focused exclusively on the private sector. We help developing countries achieve sustainable growth by fi nancing private sector investment, mobilizing capital in international fi nancial markets, and providing advisory services to businesses and governments. We play a catalytic role by demonstrating the profi tability of investments in emerging markets. Established in 1956, IFC is owned by 182 member countries, a group that collectively determines our policies. Our work in more than 100 countries allows companies and fi nancial institutions in emerging markets to create jobs, generate tax revenues, improve corporate governance and environmental performance, and contribute to their local communities. IFC’s vision is that people should have the opportunity to escape poverty and improve their lives.Publication World Development Report 1994(New York: Oxford University Press, 1994)World Development Report 1994, the seventeenth in this annual series, examines the link between infrastructure and development and explores ways in which developing countries can improve both the provision and the quality of infrastructure services. In recent decades, developing countries have made substantial investments in infrastructure, achieving dramatic gains for households and producers by expanding their access to services such as safe water, sanitation, electric power, telecommunications, and transport. Even more infrastructure investment and expansion are needed in order to extend the reach of services - especially to people living in rural areas and to the poor. But as this report shows, the quantity of investment cannot be the exclusive focus of policy. Improving the quality of infrastructure service also is vital. Both quantity and quality improvements are essential to modernize and diversify production, help countries compete internationally, and accommodate rapid urbanization. The report identifies the basic cause of poor past performance as inadequate institutional incentives for improving the provision of infrastructure. To promote more efficient and responsive service delivery, incentives need to be changed through commercial management, competition, and user involvement. Several trends are helping to improve the performance of infrastructure. First, innovation in technology and in the regulatory management of markets makes more diversity possible in the supply of services. Second, an evaluation of the role of government is leading to a shift from direct government provision of services to increasing private sector provision and recent experience in many countries with public-private partnerships is highlighting new ways to increase efficiency and expand services. Third, increased concern about social and environmental sustainability has heightened public interest in infrastructure design and performance. This report includes the World Development Indicators, which offer selected social and economic statistics for 132 countries.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.