Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso
Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso
复制标题
DOI：
10.1016/j.healthpol.2009.03.013
复制
发表时间：
2009-10-01
期刊：
影响因子：
3.3
通讯作者：
Sauerborn, Rainer
中科院分区：
文献类型：
--
作者：
Dong, Hengjin;De Allegri, Manuela;Sauerborn, Rainer
目的：本研究旨在找出参保人决定在未来几年不再续保的原因。方法：采用入户调查的方法，收集社区医疗保险退保影响因素的信息。使用CBI机构数据库中的信息描述入学和辍学的基本情况。结果：CBI自推出以来，入学率一直很低，在5.2%~6.3%之间。然而，辍学率一直很高，从30.9%到45.7%不等。多因素分析发现，女性户主、户主年龄高或文化程度低、近3个月患病次数少、家庭儿童或老人少、自感医疗质量差、近1个月就诊次数少对辍学率有正向影响，增加了辍学率。然而，家庭六个月的支出和到签约卫生机构的距离没有假想的迹象。相反，更高的家庭支出和距离签约的医疗机构更短的距离增加了辍学率。结论：高辍学率危及CBI的可持续性，不仅因为它们减少了保险池的规模，而且还因为它们对进一步的参保和辍学产生了负面影响。布基纳法索努纳卫生区计划的辍学率非常高。辍学的原因可能与负担能力、健康需要和健康需求、护理质量、户主和家庭特征有关。这项研究是进一步提高CBI计划可持续性的一次有价值的尝试，它不仅了解了是什么促使人们第一次参加CBI，而且了解了是什么促使他们年复一年地更新成员资格。(C)2009爱思唯尔爱尔兰有限公司。保留所有权利。
Objectives: This study aims to identify the reasons why enrolled people decide not to renew their membership in following years.Methods: Household survey is used to collect information on the factors influencing dropping out from community-based health insurance (CBI). Information from CBI agency databank is used to describe the general situation of enrolment and drop-out.Results: Since the launch of CBI the enrolment rate has been low ranging from 5.2% to 6.3%. The drop-out rate, however, has been high ranging from 30.9% to 45.7%. It is found, by the multivariate analysis, that female household head, higher age or lower education of a household head, lower number of illness episodes in the past three months, fewer children or elderly in a household, poor perceived health care quality, less seeking care in the past month positively effected on drop-out, increasing the rate. However, the household six-month expenditure and the distance to the contracted health facility did not have the hypothesised sign. In contrast, a higher household expenditure and a shorter distance to the contracted health facility increased the drop-out.Conclusions: High drop-out rates endanger the sustainability of CBI not only because they reduce the size of the insurance pool, but also because they bear a negative impact on further enrolment and drop-out. The drop-out rate in the scheme of the Nouna Health District, Burkina Faso, is very high. The reasons for drop-out may be related to affordability, health-needs and health demand, quality of care, household head and household characteristics. This study represents a valuable attempt towards further increasing the sustainability of CBI schemes, by understanding not what motivates people to first enrol in CBI, but what motivates them to renew membership year after year. (C) 2009 Elsevier Ireland Ltd. All rights reserved.