ABSTRACT
Objective: The main objective was to assess how group premiums can help poor people in the informal economy prepay for health care services. Methods: A comparative approach was adopted to study four groups of informal economy operators (cobblers; welders; carpenters; small scale market retailers) focusing on a method of prepayment which could help them access health care services. Two groups with a total of 714 operators were organized to prepay for health care services through a group premium; while the other two groups with a total of 702 operators were not organized to prepay through this approach. They prepaid through individual premium; each operator paying from his or her sources. Data on the four groups which lived in the same city was collected through a questionnaire and focus group discussions. Data collected was focused on health problems; health seeking behaviour and payment for health care services. Training of all the groups on prepaid health care financing based on individual based premium payment and group based premium payment was done. Groups were then free to choose which method to use in prepaying for health care. Prepayment through the two methods was then observed over a period of three years. Trends of membership attrition and retention were documented for both approaches. Results: Data collected showed that the four groups were similar in many respects. These similarities included levels of education; housing; and social services such as water supplies; health problems; family size and health seeking behaviour. At the end of a period of three years 76 of the members from the two groups who chose group premium payment were still members of the prepayment health scheme and were receiving health care. For the two groups which opted for individual premium payment only 15 of their members were still receiving health care services at the end of three years. Conclusion: Group premium is a useful tool in improving accessibility to health care services in the poorer segments of the population especially the informal economy operators