Social Inclusion and Financial Protection through Community Financing : Initial Results from Five Household Surveys

This paper provides empirical evidence regarding the performance of community-based health care financing in terms of (a) social inclusion and (b) financial protection. Five non-standardized household surveys were analyzed from India (two samples), Senegal, Rwanda, and Thailand. Common methodology was applied to the five data sets. Logistic regression was used to estimate the determinants of enrolling in a community financing scheme. A two-part model was used to assess the determinants of financial protection: part one used logistic regression to estimate the determinants of the likelihood of visiting a health care provider; part two used ordinary least-squares regression to estimate the determinants of out-of-pocket payments. The research finds: (a) Social inclusion. The findings suggest that community financing can be inclusive of the poorest even in the most economically deprived context. Nevertheless, this targeting outcome is not automatically attributable to the involvement of the community; rather it depends on key design and implementation characteristics of the schemes. (b) Financial protection. Community financing reduces financial barriers to health care as demonstrated by higher utilization and simultaneously lower out-of-pocket expenditure of scheme members controlling for a range of socioeconomic variables. The paper concludes: (a) Social inclusion. Design and implementation characteristics of community financing schemes matter to achieve good targeting outcome-community involvement alone does not guarantee social inclusion. Further research is needed to delineate which design and implementation characteristics allow better inclusion of the poor. (b) Financial protection. Prepayment and risk sharing, even on a small scale, reduce financial access barriers.

Bibliographic Details

Main Authors:	Jakab, Melitta, Preker, Alexander S., Krishnan, Chitra, Schneider, Pia, Diop, François, Jütting, Johannes, Gumber, Anil, Ranson, Kent, Supakankunt, Siripeni
Language:	English en_US
Published:	World Bank, Washington, DC 2001-09
Subjects:	ABSOLUTE POVERTY, ADDICTION, ADULT MORTALITY, ADULT MORTALITY RATE, ADVERSE SELECTION, BASIC HEALTH CARE, CHILD HEALTH SERVICES, CLINICS, COMMUNITIES, COMMUNITY CHARACTERISTICS, COMMUNITY DEVELOPMENT, COMMUNITY HEALTH, COMMUNITY PARTICIPATION, DATA COLLECTION, DATA SET, DATA SETS, DATA SOURCES, DEBT RELIEF, DECISION MAKING, DEVELOPMENT NETWORK, DIABETES, DISTRICTS, DOCTORS, DONOR COMMUNITY, ECONOMIC CHARACTERISTICS, ECONOMIC DEVELOPMENT, EMPIRICAL EVIDENCE, EMPLOYMENT, EXPENDITURES, FAMILIES, FINANCIAL SUPPORT, FINANCING MECHANISMS, HEALTH CARE, HEALTH CARE FINANCING, HEALTH CARE SERVICES, HEALTH CENTER, HEALTH CENTERS, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH FINANCING, HEALTH INSURANCE, HEALTH INSURANCE PLANS, HEALTH OUTCOMES, HEALTH POLICY, HEALTH POSTS, HEALTH REFORM, HEALTH SECTOR, HEALTH SERVICES, HEALTH SURVEY, HEALTH SYSTEM, HEALTH SYSTEMS, HOSPITAL SERVICES, HOSPITALIZATION, HOSPITALS, HOUSEHOLD CHARACTERISTICS, HOUSEHOLD DATA, HOUSEHOLD EXPENDITURES, HOUSEHOLD QUESTIONNAIRE, HOUSEHOLD SURVEY, HOUSEHOLD SURVEYS, HOUSEHOLDS, HUMAN DEVELOPMENT, HYGIENE, HYPERTENSION, ILLITERACY, IMPROVED ACCESS, INCOME, INCOME POPULATIONS, INFORMAL SECTOR, INHABITANTS, INJURIES, INPATIENT CARE, INSURANCE, INSURANCE COMPANIES, ISOLATION, LABOR FORCE, LAWS, LIFE EXPECTANCY, LIFE INSURANCE, LOW- INCOME COUNTRIES, LOW-INCOME COUNTRIES, MALARIA, MANAGEMENT CAPACITY, MEDICAL CARE, MEDICAL CARE FOR THE POOR, MEDICAL INSURANCE, MORTALITY, NATIONAL AVERAGE, NATIONAL POPULATION, NATIONAL POVERTY, NATIONAL POVERTY LINE, NATIONAL STATISTICS OFFICE, NONGOVERNMENTAL ORGANIZATIONS, NUTRITION, OUTPATIENT CARE, PATIENTS, PEDIATRICS, POLICY MEASURES, POLICY OPTIONS, POOR COMMUNITIES, POOR COUNTRIES, POOR HOUSEHOLDS, POPULATION GROUPS, POVERTY ALLEVIATION, PRIMARY HEALTH CARE, PRIVATE INSURANCE, PRIVATE SECTOR, PUBLIC HEALTH, PUBLIC HEALTH CARE, PUBLIC POLICY, PUBLIC SECTOR, RESOURCE ALLOCATION, RISK SHARING, RURAL AREAS, SAMPLE HOUSEHOLDS, SAMPLE SIZE, SAMPLING FRAME, SECTOR EMPLOYMENT, SOCIAL CAPITAL, SOCIAL EXCLUSION, SOCIAL INCLUSION, SOCIAL INSURANCE, SOCIAL PROTECTION, SOCIAL SECURITY, TECHNICAL SUPPORT, URBAN POPULATION, VILLAGES, WORKERS HEALTH CARE, HEALTH FINANCE, COMMUNITY FINANCING, POVERTY & HEALTH, SOCIOECONOMIC STATISTICS, HEALTH CARE REFORM,
Online Access:	http://documents.worldbank.org/curated/en/2001/09/3542781/social-inclusion-financial-protection-through-community-financing-initial-results-five-household-surveys https://hdl.handle.net/10986/13715
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