Access to Health Care: the Role of a Community Based Health Insurance in Kenya

Background: Out-of-pocket payments create financial barriers to health care access. There is an increasing interest in the role of community based health insurance schemes in improving equity and access of the poor to essential health care. The aim of this study was to assess the impact of Jamii Bora Health Insurance on access to health care among the urban poor. Methods: Data was obtained from the household health interview survey in Kibera and Mathare slums; which consisted of 420 respondents; aged 18 and above who were registered as members of Jamii Bora Trust. The members of Jamii Bora Trust were divided into two groups the insured and the non-insured. Results: In total; 17.9 respondents were hospitalized and women (19.6 respondents were hospitalized and women (19.6) were more likely to be admitted than men (14.7). Those in the poorest quintile had the highest probability of admission (18.1). Those with secondary school education; large household size; and aged 50 and above also had slightly greater probability of admission (p0.25). 86 of admissions among the insured respondents were covered JBHI and those in the poorest quintile were more likely to use the JBHI benefit. Results from the logistic regression revealed that the probability of being admitted; whether overall admission or admission covered by the JBHI benefit was determined by the presence of chronic condition (p0.01). Conclusion: Utilization and take up of the JBHI benefits was high. Overall; JBHI favoured the members in the lower income quintiles who were more likely to use health care services covered by the JBHI scheme

Universal Health Coverage in Rwanda: Dream or Reality

Introduction: Universal Health Coverage (UHC) has been a global concern for a long time and even more nowadays. While a number of publications are almost unanimous that Rwanda is not far from UHC; very few have focused on its financial sustainability and on its extreme external financial dependency. The objectives of this study are: (i) To assess Rwanda UHC based mainly on Community-Based Health Insurance (CBHI) from 2000 to 2012; (ii) to inform policy makers about observed gaps for a better way forward. Methods: A retrospective (2000-2012) SWOT analysis was applied to six metrics as key indicators of UHC achievement related to WHO definition; i.e. (i) health insurance and access to care; (ii) equity; (iii) package of services; (iv) rights-based approach; (v) quality of health care; (vi) financial-risk protection; and (vii) CBHI self-financing capacity (SFC) was added by the authors. Results: The first metric with 96;15 of overall health insurance coverage and 1.07 visit per capita per year versus 1 visit recommended by WHO; the second with 24;8 indigent people subsidized versus 24;1 living in extreme poverty; the third; the fourth; and the fifth metrics excellently performing; the sixth with 10.80 versus ?40 as limit acceptable of catastrophic health spending level and lastly the CBHI SFC i.e. proper cost recovery estimated at 82.55 in 2011/2012; Rwanda UHC achievements are objectively convincing. Conclusion: Rwanda UHC is not a dream but a reality if we consider all convincing results issued of the seven metrics

Group premiums in micro health insurance experiences from Tanzania

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