Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.

<h4>Aim</h4>Community Based Health Insurance (CBHI) schemes have become central to health systems financing as avenues of achieving universal health coverage in developing countries. Yet, while emphasis in research and policy has mainly concentrated on enrolment, very little has been app...

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Autores principales:	Emmanuel Nshakira-Rukundo, Essa Chanie Mussa, Min Jung Cho
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a6576c6b18864363b70b08fe5509731d
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spelling	oai:doaj.org-article:a6576c6b18864363b70b08fe5509731d2021-12-02T20:05:01ZDropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.1932-620310.1371/journal.pone.0253368https://doaj.org/article/a6576c6b18864363b70b08fe5509731d2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253368https://doaj.org/toc/1932-6203<h4>Aim</h4>Community Based Health Insurance (CBHI) schemes have become central to health systems financing as avenues of achieving universal health coverage in developing countries. Yet, while emphasis in research and policy has mainly concentrated on enrolment, very little has been apportioned to high rates of dropping out after initial enrolment. The main aim of this study is to understand the factors behind CBHI dropping out through a cross-sectional quantitative research design to gain insights into curtailing the drop out of CBHI in Uganda.<h4>Methods</h4>The survey for the quantitative research component took place between August 2015 and March 2016 covering 464 households with under-5 children in south-western Uganda. To understand the factors associated with dropping out of CBHI, we employ a multivariate logistic regression on a subsample of 251 households who were either currently enrolled or had enrolled at one time and later dropped out.<h4>Results</h4>Overall, we find that 25.1 percent of the households that had ever enrolled in insurance reported dropping out. Household socioeconomic status (wealth) was one of the key factors that associated with dropping out. Larger household sizes and distance from the hospital were significantly associated with dropping out. More socially connected households were less likely to drop out revealing the influence of community social capital in keeping households insured.<h4>Conclusion</h4>The findings have implications for addressing equity and inclusion concerns in community-based health insurance programmes such as one in south-western Uganda. Even when community based informal system aim for inclusion of the poorest, they are not enough and often the poorest of the poor slip into the cracks and remain uninsured or drop out. Moreover, policy interventions toward curtailing high dropout rates should be considered to ensure financial sustainability of CBHI schemes.Emmanuel Nshakira-RukundoEssa Chanie MussaMin Jung ChoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0253368 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Emmanuel Nshakira-Rukundo Essa Chanie Mussa Min Jung Cho Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.
description	<h4>Aim</h4>Community Based Health Insurance (CBHI) schemes have become central to health systems financing as avenues of achieving universal health coverage in developing countries. Yet, while emphasis in research and policy has mainly concentrated on enrolment, very little has been apportioned to high rates of dropping out after initial enrolment. The main aim of this study is to understand the factors behind CBHI dropping out through a cross-sectional quantitative research design to gain insights into curtailing the drop out of CBHI in Uganda.<h4>Methods</h4>The survey for the quantitative research component took place between August 2015 and March 2016 covering 464 households with under-5 children in south-western Uganda. To understand the factors associated with dropping out of CBHI, we employ a multivariate logistic regression on a subsample of 251 households who were either currently enrolled or had enrolled at one time and later dropped out.<h4>Results</h4>Overall, we find that 25.1 percent of the households that had ever enrolled in insurance reported dropping out. Household socioeconomic status (wealth) was one of the key factors that associated with dropping out. Larger household sizes and distance from the hospital were significantly associated with dropping out. More socially connected households were less likely to drop out revealing the influence of community social capital in keeping households insured.<h4>Conclusion</h4>The findings have implications for addressing equity and inclusion concerns in community-based health insurance programmes such as one in south-western Uganda. Even when community based informal system aim for inclusion of the poorest, they are not enough and often the poorest of the poor slip into the cracks and remain uninsured or drop out. Moreover, policy interventions toward curtailing high dropout rates should be considered to ensure financial sustainability of CBHI schemes.
format	article
author	Emmanuel Nshakira-Rukundo Essa Chanie Mussa Min Jung Cho
author_facet	Emmanuel Nshakira-Rukundo Essa Chanie Mussa Min Jung Cho
author_sort	Emmanuel Nshakira-Rukundo
title	Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.
title_short	Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.
title_full	Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.
title_fullStr	Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.
title_full_unstemmed	Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.
title_sort	dropping out of voluntary community-based health insurance in rural uganda: evidence from a cross-sectional study in rural south-western uganda.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a6576c6b18864363b70b08fe5509731d
work_keys_str_mv	AT emmanuelnshakirarukundo droppingoutofvoluntarycommunitybasedhealthinsuranceinruralugandaevidencefromacrosssectionalstudyinruralsouthwesternuganda AT essachaniemussa droppingoutofvoluntarycommunitybasedhealthinsuranceinruralugandaevidencefromacrosssectionalstudyinruralsouthwesternuganda AT minjungcho droppingoutofvoluntarycommunitybasedhealthinsuranceinruralugandaevidencefromacrosssectionalstudyinruralsouthwesternuganda
_version_	1718375501003751424

Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.

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