Can Community-Based Health Insurance Nudge Preventive Health Behaviours? Evidence from Rural Uganda

ZEF-Discussion Papers on Development Policy No. 270 (2019)

42 Pages Posted: 25 Jan 2019

See all articles by Emmanuel Nshakira-Rukundo

Emmanuel Nshakira-Rukundo

University of Bonn - Center for Development Research (ZEF)

Essa Mussa

University of Bonn - Center for Development Research (ZEF)

Nathan Nshakira

Kabale University

Nicolas Gerber

University of Bonn - Center for Development Research (ZEF)

Joachim von Braun

University of Bonn - Department of Economic and Technological Change

Date Written: January 14, 2019

Abstract

Community-based health insurance (CBHI) schemes have emerged as strong pathways to universal health coverage in developing countries. Their examination has largely focussed on their impacts on financial protection and on the utilisation of curative health services. However, very little is known about their possible effect on utilisation of preventive health services and strategies and yet developing countries continue to carry a burden of easily preventable illnesses. To understand if this effect exists, we carry out a cross-sectional survey in communities served by a large CBHI scheme in rural south-western Uganda. We then apply inverse probability weighting of the propensity score to analyse quasiexperimental associations. We find that the probabilities for using long-lasting mosquito nets, vitamin A and iron supplementation and child deworming were significantly increased with participation in CBHI. We postulate that this effect is partly due to information diffusion and social learning within CBHI-participating burial groups. This work gives insight into the broader effects of CBHI in developing countries, beyond financial protection and utilisation of hospital-based services.

Keywords: Community-based health insurance, Preventive Health, Inverse Probability Weighting, Rural Uganda

JEL Classification: I130, I150, I100

Suggested Citation

Nshakira-Rukundo, Emmanuel and Mussa, Essa and Nshakira, Nathan and Gerber, Nicolas and von Braun, Joachim, Can Community-Based Health Insurance Nudge Preventive Health Behaviours? Evidence from Rural Uganda (January 14, 2019). ZEF-Discussion Papers on Development Policy No. 270 (2019). Available at SSRN: https://ssrn.com/abstract=3315211 or http://dx.doi.org/10.2139/ssrn.3315211

Emmanuel Nshakira-Rukundo (Contact Author)

University of Bonn - Center for Development Research (ZEF) ( email )

Walter-Flex-Str. 3
Bonn, NRW 53113
Germany

Essa Mussa

University of Bonn - Center for Development Research (ZEF) ( email )

Walter-Flex-Str. 3
Bonn, NRW 53113
Germany

Nathan Nshakira

Kabale University ( email )

Uganda

Nicolas Gerber

University of Bonn - Center for Development Research (ZEF) ( email )

Walter-Flex-Strasse 3
Bonn, D-53113
Germany

Joachim Von Braun

University of Bonn - Department of Economic and Technological Change ( email )

Walter-Flex-Str. 3
Bonn, 53113
Germany

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