What Factors Affect Take Up of Voluntary and Community-Based Health Insurance Programmes in Low- and Middle-Income Countries? Protocol
Panda P, Dror I, Koehlmoos T, Hossain S, John D, Khan J, Dror D (2013) What factors affect take up of voluntary and community based health insurance programmes in low- and middle- income countries? A systematic review (Protocol). London: EPPI-Centre, Soc Sci Res Unit, Inst of Education, U. of London
59 Pages Posted: 5 Sep 2015
Date Written: September 2013
The penetration of commercial or public contributory health insurance to the informal sector is very poor and the scaling of successful local interventions of Community-based health insurance (CBHI) seems to be one of the promising approaches to remedy this situation. However, the existing information about the determinants of such success is lacking. There is no coherent understanding of an ideal way to implement and sustain such local efforts. Lately, there has been a proliferation of thinking about the demand for insurance and medical care, and some attempts have been made to understand demand for voluntary health insurance like CBHI in low-income countries (ILO, 2002). There seems to be few literatures pertaining to the patterns of uptake of such insurance. Evidence on determinants of enrolment with CBHI comes mostly from recent econometric modelling to predict influences of individual and household characteristics on enrolment decisions (Ito and Kono, 2010; Morsink and Geurts, 2011; Bonan et al., 2012). A few qualitative studies inform and complement studies on determinants of enrolment (Criel and Waelkens, 2003; De Allegri et al., 2006; Basaza et al., 2008), while others used mixed method approaches (Ozawa and Walker, 2009).
The research question for the proposed systematic review is the identification of key parameters that determine the uptake of voluntary and community-based health insurance in low- and middle-income countries. Our review will also cover factors affecting re-enrolment in CBHI schemes. We will follow a search strategy, using online databases related to thematic areas in the objective including social science, economics and medical science. We will search specific electronic databases which will be further supplemented by hand searching, citation tracking, and personal communication including grey literature.
The determinants of CBHI uptake would be assessed using a broad evidence base (including both quantitative and qualitative). We plan on using the PROGRESS-Plus framework of Kavanagh et al. (2008) so as to interpret the data through an equity lens viz. Place of Residence, Ethnicity, Occupation, Gender, Religion, Education, Social Capital (including peer experience with insurance, and specifically claims), Socio-economic position (SEP), Age, Disability, Sexual orientation, other vulnerable groups (e.g. disabled, HIV/AIDS, etc.). We will supplement this with topic-specific determinants such as previous exposure to insurance, having followed insurance education campaigns, and financial literacy in general (i.e. previous experience with micro-finance in the broad sense – credit and savings). For all included studies in addition to describing their study design, we will also assess their quality. We will assess the quality of included studies using checklist (Waddington et al., 2012), making judgments on the adequacy of reporting, data collection, presentation, analysis and conclusions drawn. It is important to assess the methodological quality of individual studies (i.e. validity assessment) as it may affect both the results of the individual studies and ultimately the conclusions reached from the body of studies.
A success of this project is also linked to our ability to collecting the information that is scattered in many data sources, analysis of the data and translation of this analysis to a set of coherent general guidelines for successful implementation of voluntary health insurance among the poor in low income countries. Through the identification of groups particularly within South and South East Asia that are working on CBHI as well as through the course of the review; We aim to emphasize the creation of knowledge translation tools e.g. websites, policy briefs, newspapers, articles that can reach the end-line users such as policy-makers, donors and civil society organizations through conference presentations, policy briefs and contributing to the updating and maintenance of existing webpages. This would be enabled by an advisory group comprising of policy-makers, donors, methodology expert and other researchers active in the area of initiatives for pro-poor insurance coverage in LMIC.
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