Proposed Prepayment Scheme for Harare, Zimbabwe

2016

2016

Indian Journal of Human Development, 2008

The health system in India is inaccessible to a majority of the poor, who are ironically known to be more susceptible to disease. While the direct public provision of healthcare services has not been successful, alternate means of healthcare financing like user-fee have also largely been failures. In this context, community-based health insurance is being recognized as an important financing tool for improving access to health services for the poor. Indeed, several communitybased health insurance (CBHI) initiatives have come up in different parts of rural and semi-rural India. The United Nations Development Programme (UNDP), with the help of other agencies, has initiated three CBHI schemes in three different regions in India. Differences in their design and implementation offer an interesting case for studying their impact. The objective of this study is to assess whether members of UNDP-sponsored CBHI schemes have had better access to healthcare. Based on a survey of 600 households...

The Impact of CBHI on Health Utilization, 2018

Many countries are being challenged to meet Universal Health Coverage (UHC) because of their weak health systems, poor quality of health services and insufficient financing capacity. Ethiopia has implemented community based health insurance to reduce households` cost they expend for health care and to scale up service utilization. Studies showed the impact of community based health insurance on health access and utilization as well as how it mitigated financial hardships. Hence, the general objective of the study is to assess the impact of the community based health insurance on health care service utilization of households in North Achefer Woreda, West Gojjam Zone, Amhara region, Ethiopia. To bring up the results, the study used cross-sectional household survey data both from CBHI members and non-members. The study used clustering method to select the sample kebeles and random sampling method to select the respondents. For qualitative data, focus group discussions and key informants’ interviews has been applied. Descriptive statistics and econometric models such as PSM and ESR have been used to analyze the data. The result of PSM shows that households who enrolled in CBHI scheme have 1.05 to 1.35 more frequency visits and 5.4 – 7.5 percent more awareness on family planning than not-enrolled households. It also depicts that non-CBHI enrolled households have from 11.83 birr to 17.96 birr more monthly health care expenditure than treated groups. But PSM does not account for endogeneity and self-selection bias in participating in CBHI scheme, so that ESR results are more robust and reliable. Accordingly, for households participating in CBHI scheme, the expected average frequency of visit of them would have been less by 0.89, their expected average monthly expenditure would have been 7.9 birr more and their awareness on family planning would have been less by 13.1 percent, if they did not enroll to the scheme. Therefore, this study recommends the respective bodies to focus on awareness creation on health care utilization. Hence, the community can develop health seeking behavior and can use CBHI as an opportunity to get health care services with low cost. Key Words: Health care utilization, Health care expenditure, Family planning, CBHI, PSM, ESR, North Achefer Woreda

2016

Social Science & Medicine, 1999

The Bwamanda hospital insurance scheme in Zaire was launched in the mid-eighties and is one of the few wellestablished and documented initiatives in the ®eld of district-based insurance schemes in sub-Saharan Africa. It was established that hospital utilization in Bwamanda is signi®cantly higher among the insured population. A higher hospital utilization is however not a goal in itself: it is a positive phenomenon if it takes place for problems where the hospital's know-how and technology are needed to solve the patient's problem. This paper investigates the eect of the insurance scheme on hospital utilization patterns. More speci®cally, the distribution of this higher utilization over the dierent hospital departments, as well as its spatial distribution in the entire district area are analyzed. The impact of the insurance scheme on the eectiveness, equity and eciency of hospital utilization are discussed. The relevance and possible implications of these ®ndings on the design of the Bwamanda insurance scheme are discussed. Finally, it is argued that the methods used in the present study contribute to a coherent framework for the evaluation of similar initiatives. #

Social Science & Medicine, 1995

ln most developing countries, government funding allocated to the health services is not sufficient to allow these services to provide appropriate health care accessible to all. Consequently, community financing has received much more attention in recent years and innovative schemes are being explored throughout the developing world. Risk-sharing schemes, like prepayment, are interesting because of their potential redistributive effects. At the end of the eighties, a prepayment scheme for hospital care was experimented with in the Masisi health district in Eastern Zaire. In the present paper, the experiment is described in a chronological way and the results are analyzed and discussed in detail. Although this particular case-study was not successful, it yields important lessons concerning the design, implementation and evaluation of prepayment schemes for hospital health care in developing countries. More specifically, phenomena like adverse selection and moral hazard are discussed. Finally, conditions for success of similar experiments are discussed. These conditions relate mainly to the organization pattern of the district health services system. The Masisi experiment is a nice illustration of the fact that prepayment is not a 'magic bullet': the lessons drawn from it may be of relevancy to health planners intending to implement hospital prepayment schemes in similar settings.

mfcindia.org

Journal of Hospital Management and Health Policy

Background: Ensuring value for health sector spending is a universal concern for policy makers in lowand middle-income countries (LMICs), where health care demands are rising and health sector financing is limited. Performance-based financing (PBF) is more frequently being implemented in LMICs to improve quality of care and ultimately health system outcomes. Through PBF, LMICs can potentially reduce variation in clinical practice, because PBF provider incentives are directly linked to achievement of predefined quality of care standards and adherence to quality protocols. Zimbabwe implemented PBF in 16 districts as a health system reform to improve the quality and coverage of health services from 2011. This paper first estimates the impact of PBF on quality of care, and then explores contextual factors mediating the effectiveness of PBF in improving quality of care in Zimbabwe. Methods: The World Bank collected household and health facility data in 2010/2011 and 2014 (baseline and end line years, respectively). Thirty-two districts served as the total study sample for the impact evaluation, comprising 16 PBF pilot districts and 16 comparison districts. These 32 districts were purposively sampled out of Zimbabwe's 64 districts and then pair-matched on the basis of observable information described below. The pair-matching process sought to improve the power of inference and provide balance on observable district and facility characteristics. Two datasets were merged and then analyzed, one with household information and the other with health facility and health worker information. Pairing of households with health facilities was done at the community level. Baseline imbalances were adjusted for by difference-indifference (DID) regression analysis. Contextual factors were analyzed to determine the most influential factors. Quality of care was measured for antenatal care (ANC), extended program on immunization (EPI), institutional deliveries, curative care, and postnatal care (PNC) services. A composite quality of care index was created using these five health services. Results: Overall, PBF was found to have no effect on quality of care for services, except for institutional deliveries. PBF improved quality of institutional delivery by 0.01 percentage points. Results of individual contextual factors on their impact of PBF on quality of care were varied. An increase in the distance between health facilities and communities decreased the impact of PBF on quality of care by about 1.21% (P=0.0020), while distance from the district capital had no impact on PBF effects on quality of care. The size of the catchment area, mean population wealth, and availability of skilled health workers had no impact on PBF effects on quality of care. However, health workers' job satisfaction increased the impact of PBF on quality of ^ ORCID: 0000-0002-0332-3169.