Value for Solidarity: a Proxy for Community Understanding and Acceptance of the Basic Principles of Community-based Health Insurance in Rural Ethiopia

Overview

Journal Health Econ Rev

Publisher Biomed Central

Specialty Public Health

Date 2024 Oct 4

PMID 39365415

Authors

Mohammed Hussien

Affiliations

Soon will be listed here.

Abstract

Background: Solidarity is an aspect of human association that gives emphasis to the cohesive social bond that holds a group together and is valued and understood by all members of the group. A lack of understanding of the solidarity principle is one of the main reasons for low population coverage in microhealth insurance schemes. This study aimed to examine the extent to which people value solidarity and the factors that explain the differences.

Methods: A community-based cross-sectional study was carried out in two districts of northeast Ethiopia among 1232 randomly selected households which have ever been registered in a community-based health insurance scheme. Face-to-face interviews were conducted with household heads using a standardized questionnaire deployed to an electronic data collection platform. Solidarity was measured using three dimensions: income solidarity, risk solidarity, and cost coverage. Principal component analysis was used to construct composite variables, and the reliability of the tools was checked using Cronbach's alpha. A multivariable analysis was performed using the partial proportional odds model to determine the associations between variables. The degree of association was assessed using the odds ratio, and statistical significance was determined at 95% confidence interval.

Results: Three-quarters (75%) of the respondents rated risk solidarity as high, while 70% and 63% rated income solidarity and cost coverage as high, respectively. Place of residence (AOR = 2.23; 95% CI: 1.68, 2.94), wealth index (AOR = 1.51; 95% CI: 1.07, 2.12), self-rated health status (AOR = 1.64; 95% CI: 1.12, 2.40), trust in insurance schemes (AOR = 1.68; 95% CI: 1.22, 2.30), perceived quality of care (AOR = 1.75; 95% CI: 1.33, 2.31) and frequency of outpatient visits (AOR = 2.05; 95% CI: 1.30, 3.24) were significant predictors of value for solidarity.

Conclusions: The community placed greater value for solidarity, indicating community understanding and acceptance of the core principles of microhealth insurance. Administrators of the insurance scheme, health authorities, and other actors should strive to create a transparent management system and improve access to high-quality health care, which will facilitate community acceptance of the insurance scheme and its guiding principles.

References

Maritim B, Koon A, Kimaina A, Goudge J . Acceptability of prepayment, social solidarity and cross-subsidies in national health insurance: A mixed methods study in Western Kenya. Front Public Health. 2022; 10:957528. PMC: 9614422. DOI: 10.3389/fpubh.2022.957528. View

Muhammad T, Kumar P, Srivastava S . How socioeconomic status, social capital and functional independence are associated with subjective wellbeing among older Indian adults? A structural equation modeling analysis. BMC Public Health. 2022; 22(1):1836. PMC: 9523926. DOI: 10.1186/s12889-022-14215-4. View

Maarse H, Paulus A . Has solidarity survived? A comparative analysis of the effect of social health insurance reform in four European countries. J Health Polit Policy Law. 2003; 28(4):585-614. DOI: 10.1215/03616878-28-4-585. View

Umeh C . Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania. Int J Health Plann Manage. 2018; 33(4):794-805. DOI: 10.1002/hpm.2610. View

Hu Y, Zhang Z, Xie J, Wang G . The Outpatient Experience Questionnaire of comprehensive public hospital in China: development, validity and reliability. Int J Qual Health Care. 2016; 29(1):40-46. DOI: 10.1093/intqhc/mzw133. View

Evans D, Etienne C . Health systems financing and the path to universal coverage. Bull World Health Organ. 2010; 88(6):402. PMC: 2878164. DOI: 10.2471/BLT.10.078741. View

Fadlallah R, El-Jardali F, Hemadi N, Morsi R, Abou Samra C, Ahmad A . Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review. Int J Equity Health. 2018; 17(1):13. PMC: 5789675. DOI: 10.1186/s12939-018-0721-4. View

. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016-40. Lancet. 2018; 391(10132):1783-1798. PMC: 5946843. DOI: 10.1016/S0140-6736(18)30697-4. View

Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K . Pooling financial resources for universal health coverage: options for reform. Bull World Health Organ. 2020; 98(2):132-139. PMC: 6986215. DOI: 10.2471/BLT.19.234153. View

10.

Meijer M, Brabers A, de Jong J . Social context matters: The role of social support and social norms in support for solidarity in healthcare financing. PLoS One. 2023; 18(9):e0291530. PMC: 10501638. DOI: 10.1371/journal.pone.0291530. View

11.

Akachi Y, Kruk M . Quality of care: measuring a neglected driver of improved health. Bull World Health Organ. 2017; 95(6):465-472. PMC: 5463815. DOI: 10.2471/BLT.16.180190. View

12.

Ridde V, Asomaning Antwi A, Boidin B, Chemouni B, Hane F, Toure L . Time to abandon amateurism and volunteerism: addressing tensions between the Alma-Ata principle of community participation and the effectiveness of community-based health insurance in Africa. BMJ Glob Health. 2018; 3(Suppl 3):e001056. PMC: 6195139. DOI: 10.1136/bmjgh-2018-001056. View

13.

Mladovsky P . Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal. Soc Sci Med. 2014; 107:78-88. DOI: 10.1016/j.socscimed.2014.02.008. View

14.

Shewamene Z, Tiruneh G, Abraha A, Reshad A, Terefe M, Shimels T . Barriers to uptake of community-based health insurance in sub-Saharan Africa: a systematic review. Health Policy Plan. 2021; 36(10):1705-1714. DOI: 10.1093/heapol/czab080. View

15.

Turcotte-Tremblay A, Haddad S, Yacoubou I, Fournier P . Mapping of initiatives to increase membership in mutual health organizations in Benin. Int J Equity Health. 2012; 11:74. PMC: 3541096. DOI: 10.1186/1475-9276-11-74. View

16.

Demissie G, Atnafu A . Barriers and Facilitators of Community-Based Health Insurance Membership in Rural Amhara Region, Northwest Ethiopia: A Qualitative Study. Clinicoecon Outcomes Res. 2021; 13:343-348. PMC: 8106446. DOI: 10.2147/CEOR.S293847. View

17.

Webster T, Mantopoulos J, Jackson E, Cole-Lewis H, Kidane L, Kebede S . A brief questionnaire for assessing patient healthcare experiences in low-income settings. Int J Qual Health Care. 2011; 23(3):258-68. DOI: 10.1093/intqhc/mzr019. View

18.

Dror D, Hossain S, Majumdar A, Perez Koehlmoos T, John D, Panda P . What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis. PLoS One. 2016; 11(8):e0160479. PMC: 5006971. DOI: 10.1371/journal.pone.0160479. View

19.

Reich M, Harris J, Ikegami N, Maeda A, Cashin C, Araujo E . Moving towards universal health coverage: lessons from 11 country studies. Lancet. 2015; 387(10020):811-6. DOI: 10.1016/S0140-6736(15)60002-2. View

20.

Dieleman J, Templin T, Sadat N, Reidy P, Chapin A, Foreman K . National spending on health by source for 184 countries between 2013 and 2040. Lancet. 2016; 387(10037):2521-35. DOI: 10.1016/S0140-6736(16)30167-2. View