170949 Above and below the poverty line: Is community-based health insurance an effective tool to prevent impoverishment related to healthcare expenditure in low-income countries?

Wednesday, October 29, 2008: 10:30 AM

Slim Haddad, MD, PhD , Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
Florence Morestin, MSc , Unité de Santé Internationale / International Health Unit, Université de Montréal, Montréal, QC, Canada
Purpose: Community-based health insurance (CBHI) has been promoted as a means to prevent catastrophic healthcare expenditure and household impoverishment in low- and middle-income countries. This study aims to assess how the generalization of CBHI would impact poverty in Burkina Faso. Data & Methods: 1604 households were surveyed about their healthcare consumption. Impoverishment attributable to direct healthcare expenditure was measured by comparing the incidence levels of poverty and the poverty gaps before and after health expenditure. The results were compared to the level of impoverishment under two simulated scenarios: 1) all households are subscribers of a CBHI; 2) same scenario, with external subsidies to fund poor households' premiums. Results: Without insurance, out-of-pocket health expenditures impoverish the poor further and drag some previously non-poor households below the poverty line. Being insured does not meaningfully modify the average level of households' spending on health. Since most households can only afford low premiums, balancing inflows and outflows implies leaving some health expenses uncovered and imposing co-payments. Reimbursements often do not offset the premiums and co-payments. The implementation of insurance benefits mostly the wealthier households (decrease in their health expenditures). For poor households, the balance of gains (reduction in the economic burden of healthcare) and losses (premium costs) is not favorable, unless their premiums are subsidized. Intermediate households' total health expenditures increase when insured. The CBHI does not reduce the proportion of households falling into poverty due to health expenditure. Policy implications: CBHI is not a magic bullet to mitigate the impoverishing impact of user fees. Countries and the international community cannot withdraw from their responsibilities in finding new solutions to the crisis of health financing in low-income countries.

Learning Objectives:
- Discuss the ability of community-based health insurance to protect households from health-related impoverishment in the context of user fees. - Identify the financial advantages and drawbacks for households in joining a community-based health insurance, depending on their level of income and health utilization and on the insurance package.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principle investigator / contributor.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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