Community-based Health Insurance
PST 06105: HEALTH FINANCING
Session 6: Community-based Health Insurance
Learning Tasks
At the end of this session students are expected to be able to:
Define
community-based health insurance
Explain
how community-based health insurance operates in the health sector
Enumerate
advantages and disadvantages community-based health insurance
Activity: Brainstorming
What is community-based health insurance?
3
Community-based
Health
Insurance (CHI)
Community-based health insurance (CHI) is part of an overall health financing strategy in
a
number of developing
countries are
sometimes referred to as health insurances for
the
informal sector, micro–health insurances, mutual health organizations, or
micro insurance schemes
CHI is
defined as a
not-for-profit prepayment
plans for health care controlled
by community
and have voluntary membership
Community
, using representatives, manages the collection of resources and purchase
of health
services
CHIs
were actively promoted by UNICEF for people in the informal sector in
1980-1990s through
Bamako Initiative
It
is a voluntary and prepayment scheme where community pay a set premium to
the scheme
.
Community-based
Health
Insurance (CHI)
The
premium is based on community rating (based on pooled risk of defined population)
The
prominent community-based health insurance in Tanzania is known as Community
Health
Fund (CHF), which currently operated by local governments within a
local government
There
two forms of CHF in Tanzania:
Ordinary
CHF:
Improved
CHF
Community-based
Health Insurance
Ordinary CHF
has the following features:
No
separation between purchaser and providers of health services, that is, the
Council Health
Service Board represents both the interests of CHF members and health
care providers
(health facilities)
Weak
data management system
Passive
enrolment strategy based on health facilities
Restricted
benefit package with card applicable at the enrolled facility and rarely
involving
hospital services
Passive
to no community
sensitization
campaigns
Identity
card given to head of the household (only one card for the household)
Community-based
Health Insurance
Improved CHF
has the following features:
Reorganized
structure that displays the different roles of purchaser (CHF) and health
care
provider (health facilities)
Reform
of data management system by installation and use of an insurance
management
system with a central server with online and offline modes
Active
close‐to‐client strategy with village‐level enrolment officers
Expanded
range of services to include
hospitalisation
and portability of CHF cards
within
the region
Active mobilization
campaigns with social marketing strategies that involve both
community‐based
campaigns and mass media campaigns
Each
member of the household is given individual membership cards
Activity: Brainstorming
How does community-based health insurance operate?
8
Operation of Community-based Health Insurance
Operation
of Community-based Health Insurance
CHI involves two parties:
citizen
and
users
of health services and
providers
of health
services
In
CHI arrangement,
specified
group of people or households (e.g. within a
local government
) pay premium to providers of public health services (.e.g. dispensaries,
health
centres
, hospitals) before they fall
sick
Addition
to premium paid, households receive a “matching grant” from the
central government
, which is equivalent to the premiums paid by the enrolled households
in Tanzania
In
return, insured members of the community receive health services when they fall sick
Providers
of public health services
collection,
and use financial resources pay
for medicines
costs, laboratory tests, supply and medical material costs, entrance
fee or
consultation
fees
Additional details of CHF are provided in
Hand out 1
Operation
of Community-based Health Insurance
T
here
are factors, reported by researchers that influence operation of CHF in Tanzania;
these factors are reported in the following table 5.1 below.
Activity:
Small group discussion
What are the advantages and disadvantages of Community-based health insurance?
12
Advantages of CHI
Advantages
(strengths) of CHI are as follows:
Provide
better access to health care for low-income people or the informal sector
CHI
do provide additional financial resources earmarked for health
Provide
some protection to their members
Disadvantages of CHI
CHI has limited ability to raise significant resources due to low overall income of the
community
Limited
population coverage due to: people do not understand the need for health
insurance
, voluntary nature of schemes, and they do not trust the managers of
the scheme
Sustainability
is questionable for most CHIs due to small size of the
pool(population coverage
), which makes many community based health insurance schemes
vulnerable to
failure
Voluntary
community health insurances are liable to risks related to
adverse selection(individuals
are able to purchase insurance at rates that are below
actuarially fair
rates and cream skimming (seek to
enroll
only so called good risks and
avoid enrolling
customers whose profile suggests that they are unhealthy with
chronic disease
)
Key Points
CHI
is now promoted as an alternative financing in developing for raising
financing resources
for the health sector and for ensuring that people informal sector have access to
health
services
CHI
involve two main parties in health service: citizen and user of health services and
an network
of providers of the health service
CHI
has both advantages and disadvantages
There
are factors that constraint the performance and operation of CHI
Evaluation
What
is community-based health insurance?
List
are the parties involved in CHI
What
are advantages and disadvantages of CHI?
What
are the factors that facilitate operation of CHF in Tanzania?
Reference
Ekman
, B. (2004). Community-based health insurance in low-income countries: a
systematic review
of the evidence. Health policy and planning, 19(5), 249-270
Gottret
, P.
Schieber
, G. (2006). Health financing revisited: a
practioner’s
guide. World Bank
Green
, A. (2007). An introduction to health planning for developing health systems. Oxford:
Oxford
University
Press
Kalolo
, A., Gautier, L.,
Radermacher
, R.,
Stoermer
, M.,
Jahn
, A.,
Meshack
, M., &
De
Allegri
, M. (2018). Implementation of the redesigned Community Health Fund in
the Dodoma
region of Tanzania: A qualitative study of views from
rural communities
. The International journal of health planning and management, 33(1
), 121-135
Tanzania
.
MoHSW
(2014). DHM Healthcare financing module. Dar
es
Salaam:
MoHSW
WHO
(2003). Mental health financing. Geneva, WHO.
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