Provider payment in community-based health insurance schemes in developing countries: A systematic review

Health Policy and Planning

Volumn 28, Issue 2, 2013, Pages 111-122

  Robyn, Paul Jacob ^a   Sauerborn, Rainer ^a   Bärnighausen, Till ^b,c  

^a UNIVERSITY OF HEIDELBERG   (Germany)

^b HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^c UNIVERSITY OF KWAZULU NATAL   (South Africa)

Author keywords

Developing country; Health insurance; Systematic review; Third party payments

Indexed keywords

COMMUNITY CARE; DEVELOPING COUNTRY; ECONOMICS; HEALTH INSURANCE; HUMAN; ORGANIZATION AND MANAGEMENT; PATIENT SATISFACTION; REIMBURSEMENT; REVIEW;

COMMUNITY HEALTH SERVICES; DEVELOPING COUNTRIES; HUMANS; INSURANCE, HEALTH; INSURANCE, HEALTH, REIMBURSEMENT; PATIENT SATISFACTION; REIMBURSEMENT MECHANISMS;

EID: 84874819825     PISSN: 02681080     EISSN: 14602237     Source Type: Journal    
DOI: 10.1093/heapol/czs034     Document Type: Review

References (55)

1. Aggarwal A. 2010. Impact evaluation of India's 'Yeshasvini' communitybased health insurance programme. Health Economics 19(Suppl.): 5-35.
2. Agyepong I, Adjei S. 2008. Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme. Health Policy and Planning 23: 150-60. (Pubitemid 351301889)
3. Ahmed M, Islam S, Quashem A, Ahmed N. 2005. Health microinsurance: a comparative study of three examples in Bangladesh. CGAP Working Group on Microinsurance, Good and Bad Practices, Case Study No. 13.
4. Alton V, Eckerlund I, Norlund A. 2006. Health economic evaluations: how to find them. International Journal of Technology Assessment in Health Care 22: 512-17. (Pubitemid 44622973)
5. Atim C. 1999. Social movements and health insurance: a critical evaluation of voluntary, non-profit insurance schemes with case studies from Ghana and Cameroon. Social Science & Medicine 48: 881-96. (Pubitemid 29090537)
6. Bärnighausen T, Liu Y, Zhang X, Sauerborn R. 2007. Willingness to pay for social health insurance among informal sector workers in Wuhan, China: a contingent valuation study. BMC Health Services Research 7: 114.
7. Bärnighausen T, Sauerborn R. 2002. One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries? Social Science & Medicine 54: 1559-87. (Pubitemid 34309017)
8. Basaza R, Criel B, Van der Stuyft P. 2007. Low enrollment in Ugandan community health insurance schemes: underlying causes and policy implications. BMC Health Services Research 7: 105.
9. Basaza R, Criel B, Van der Stuyft P. 2008. Community health insurance in Uganda: why does enrolment remain low? A view from beneath. Health Policy 87: 172-84.
10. Bennett S. 2004. The role of community-based health insurance within the health care financing system: a framework for analysis. Health Policy and Planning 19: 147-58. (Pubitemid 38623168)
11. Carrin G, Doetinchem O, Kirigia J, Mathauer I, Musango L. 2008. Social health insurance: how feasible is its expansion in the African region? Development ISSues. The Hague: Institute of Social Studies.
12. Carrin G, Hanvoravongchai P. 2003. Provider payments and patient charges as policy tools for cost-containment: how successful are they in high-income countries? Human Resources for Health 1: 6.
13. Chee G, Smith K, Kapinga A. 2002. Assessment of the Community Health Fund in Hanang District, Tanzania. Bethesda, MD: Partners for Health Reformplus Project, Abt Associates Inc.
14. Criel B, Diallo AA, Van der Vennet J, Waelkens MP, Wiegandt A. 2005. Difficulties in partnerships between health professionals and mutual health organisations: the case of Maliando in Guinea-Conakry. Tropical Medicine & International Health 10: 450-63. (Pubitemid 40712430)
15. Criel B, Waelkens MP. 2003. Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong? Social Science & Medicine 57: 1205-19. (Pubitemid 36945247)
16. De Allegri M, Kouyate B, Becher H et al. 2006a. Understanding enrolment in community health insurance in sub-Saharan Africa: population-based case-control study in rural Burkina Faso. Bulletin of the World Health Organization 84: 852-8. (Pubitemid 44714420)
17. De Allegri M, Sanon M, Sauerborn R. 2006b. "To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa. Social Science & Medicine 62: 1520-7. (Pubitemid 43197834)
18. Desmet M, Chowdhury AQ, Islam MK. 1999. The potential for social mobilisation in Bangladesh: the organisation and functioning of two health insurance schemes. Social Science & Medicine 48: 925-38. (Pubitemid 29090540)
19. Devadasan N, Ranson K, Van Damme W, Acharya A, Criel B. 2006. The landscape of community health insurance in India: an overview based on 10 case studies. Health Policy 78: 224-34. (Pubitemid 44247209)
20. Dong H, De Allegri M, Gnawali D, Souares A, Sauerborn R. 2009. Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso. Health Policy 92: 174-9.
21. Dror DM, Radermacher R, Khadilkar SB et al. 2009. Microinsurance: innovations in low-cost health insurance. Health Affairs (Millwood) 28: 1788-98.
22. Ekman B. 2004. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy and Planning 19: 249-70. (Pubitemid 39150130)
23. Faden L, Vialle-Valentin C, Ross-Degnan D, Wagner A. 2011. Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: a systematic review of current evidence. Health Policy 100: 134-43.
24. Franco LM, Diop FP, Burgert CR et al. 2008. Effects of mutual health organizations on use of priority health-care services in urban and rural Mali: a case-control study. Bulletin of the World Health Organization 86: 830-8.
25. Frenk J, Gonzalez-Pier E, Gomez-Dantes O, Lezana MA, Knaul FM. 2006. Comprehensive reform to improve health system performance in Mexico. The Lancet 368: 1524-34. (Pubitemid 44634673)
26. Gnawali DP, Pokhrel S, Sie A et al. 2009. The effect of community-based health insurance on the utilization of modern health care services: evidence from Burkina Faso. Health Policy 90: 214-22.
27. Gottret PE, Schieber G. 2006. Health Financing Revisited: A Practitioner's Guide. Washington, DC: The World Bank.
28. Higgins J, Green S (eds). 2008. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration. Online at: http://www.cochrane. org/training/cochrane-handbook, accessed 23 March 2012.
29. McIntyre D, Thiede M, Dahlgren G, Whitehead M. 2006. What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Social Science & Medicine 62: 858-65. (Pubitemid 43087361)
30. Meessen B, Zhenzhong Z, van Damme W et al. 2003. Editorial: Iatrogenic poverty. Tropical Medicine & International Health 8: 581-4. (Pubitemid 36836500)
31. Mills A, Bennett S, Siriwanarangsun P, Tangcharoensathien V. 2000. The response of providers to capitation payment: a case-study from Thailand. Health Policy 51: 163-80. (Pubitemid 30138051)
32. Musango L, Dujardin B, Dramaix M, Criel B. 2004. [Profile of members and non members of mutual health insurance system in Rwanda: the case of the health district of Kabutare]. Tropical Medicine & International Health 9: 1222-7. (Pubitemid 39573996)
33. Nguyen HT, Rajkotia Y, Wang H. 2011. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts. International Journal of Equity in Health 10: 4.
34. Ogawa S, Hasegawa T, Carrin G, Kawabata K. 2003. Scaling up community health insurance: Japan's experience with the 19th century Jyorei scheme. Health Policy and Planning 18: 270-8. (Pubitemid 37087216)
35. Onwujekwe O, Onoka C, Uzochukwu B et al. 2009. Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria. Health Policy 92: 96-102.
36. Ranson MK. 2002. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bulletin of the World Health Organization 80: 613-21.
37. Ranson MK, John KR. 2001. Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance. Health Policy and Planning 16: 395-403. (Pubitemid 34015398)
38. Ranson MK, Sinha T, Chatterjee M et al. 2006. Making health insurance work for the poor: learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India. Social Science & Medicine 62: 707-20. (Pubitemid 41797025)
39. Ranson MK, Sinha T, Chatterjee M et al. 2007. Equitable utilisation of Indian community based health insurance scheme among its rural membership: cluster randomised controlled trial. British Medical Journal 334: 1309.
40. Rao KD, Waters H, Steinhardt L et al. 2009. An experiment with community health funds in Afghanistan. Health Policy and Planning 24: 301-11.
41. Roberts M, Hsiao W, Berman P, Reich M. 2008. Getting Health Reform Right: A Guide to Improving Performance and Equity. New York: Oxford University Press.
42. Ron A. 1999. NGOs in community health insurance schemes: examples from Guatemala and the Philippines. Social Science & Medicine 48: 939-50. (Pubitemid 29090541)
43. Schneider P, Hanson K. 2006. Horizontal equity in utilisation of care and fairness of health financing: a comparison of microhealth insurance and user fees in Rwanda. Health Economics 15: 19-31. (Pubitemid 43141523)
44. Schneider P, Hanson K. 2007. The impact of micro health insurance on Rwandan health centre costs. Health Policy and Planning 22: 40-8. (Pubitemid 46181141)
45. Smith KV, Sulzbach S. 2008. Community-based health insurance and access to maternal health services: evidence from three West African countries. Social Science & Medicine 66: 2460-73. (Pubitemid 351657634)
46. Sun X, Jackson S, Carmichael GA, Sleigh AC. 2009. Prescribing behaviour of village doctors under China's New Cooperative Medical Scheme. Social Science & Medicine 68: 1775-9.
47. The Cochrane Collaboration. 2011. Glossary. Online at: http://www .cochrane.org/glossary/5#letterg, accessed 23 March 2012.
48. Waelkens MP, Criel B. 2004. Les mutuelles de sante en Afrique sub-Saharienne - Etat des Lieux et Reflexions sur un Agenda de Recherche. HNP Discussion Paper. Washington, DC: World Bank.
49. Wang H, Yip W, Zhang L, Hsiao WC. 2009. The impact of rural mutual health care on health status: evaluation of a social experiment in rural China. Health Economics 18(Suppl. 2):S65-82.
50. WHO. 2000. The World Health Report 2000 - Health Systems: Improving Performance. Geneva: World Health Organization.
51. Woolhandler S, Himmelstein DU. 2002. Paying for national health insurance - and not getting it. Health Affairs (Millwood) 21: 88-98.
52. World Bank. 2010. World Development Indicators. Online at: http://data .worldbank.org/data-catalog/world-development-indicators, accessed 23 March 2012.
53. Xu K, Evans DB, Carrin G et al. 2007. Protecting households from catastrophic health spending. Health Affairs (Millwood) 26: 972-83.
54. Yevutsey SK, Aikins M. 2010. Financial viability of district mutual health insurance schemes of lawra and sissala East districts, Upper West Region, Ghana. Ghana Medical Journal 44: 130-7.
55. Zhou Z, Gao J, Xue Q, Yang X, Yan J. 2009. Effects of Rural Mutual Health Care on outpatient service utilization in Chinese village medical institutions: evidence from panel data. Health Economics 18(Suppl. 2):S129-36.