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Applied Health Economics and Health Policy
Published in: Applied Health Economics and Health Policy 2/2017

01-04-2017 | Original Research Article

Determinants of Voluntary National Health Insurance Drop-Out in Eastern Sudan

Authors: Chantal Herberholz, Wael Ahmed Fakihammed

Published in: Applied Health Economics and Health Policy | Issue 2/2017

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Abstract

Background

Low enrolment and high drop-out rates are common problems in voluntary health insurance schemes. Yet, most studies in this research area focus on community-based health insurance and enrolment, rather than drop-out.

Objective

This study examines what causes informal sector families not to renew their voluntary National Health Insurance Fund (NHIF) health insurance membership in Eastern Sudan.

Methods

Primary data from about 600 informal sector households that dropped out or remained insured, collected through a household survey conducted in March 2014, were used. Logistic regressions were employed to examine what determines drop-out of the voluntary NHIF scheme.

Results

The logistic regression results are consistent with the existing literature and confirm the importance of household head, household and community characteristics. Notably, worse family health status and higher health care utilization decrease the probability of drop-out, which requires further analysis as it may indicate the problem of adverse selection and insufficient risk management. Most importantly, the results consistently show that household heads who are satisfied with health services and those who understand the main features of the voluntary NHIF scheme are less likely to drop out. Also, 30 % of drop-out households hold a social support card and reported that the social support scheme is the main reason for not renewing their voluntary NHIF health insurance membership as they qualify for sponsored NHIF health insurance membership.

Conclusions

This study shows that satisfaction with health services and knowledge of the health insurance scheme are important factors explaining drop-out of a national health insurance programme. The results suggest that education and information campaigns should be developed further to raise understanding of the NHIF voluntary scheme. In addition, information systems and coordination between the main agencies should be strengthened to reduce administrative costs and ensure policy coherence.
Footnotes
1
The World Health Organization (WHO), however, reported that the total expenditure on health as a percentage of GDP stood at 8.4 in 2011 [29].
 
2
A combined dataset, comprising the dataset used in this study and additional data collected from never-insured individuals using convenience sampling, was used in Fakihammed [36].
 
3
The Sudan Technical and Ethical Review Committee, whose approval was obtained, set a range of 30–40 for the total number of blocks/villages.
 
4
The authors are grateful to an anonymous referee for suggesting this.
 
Literature
1.
Carrin G, James C. Reaching universal coverage via social health insurance: key design features in the transition period. Geneva: World Health Organization; 2004.
2.
3.
Gottret P, Schieber G. Health financing revisited: a practitioner’s guide. Washington DC: The World Bank; 2006.CrossRef
4.
Wang H, Pielemeier N. Community-based health insurance: an evolutionary approach to achieving universal coverage in low-income countries. J Life Sci. 2012;6:320–9.
5.
6.
7.
8.
Sudan Federal Ministry of Health. Health system financing review report. Khartoum: Public Health Institute, Federal Ministry of Health; 2014.
9.
Central Bureau of Statistics, The Republic of Sudan. Statistical year book for the year 2009. Khartoum: Central Bureau of Statistics, The Republic of Sudan; 2010.
10.
Mebratie AD, Sparrow R, Alemu G, Bedi AS. Community-based health insurance schemes: a systematic review. The Hague: Institute of Social Studies; 2013.
11.
De Allegri M, Sauerborn R, Kouyate B, Flessa S. Community health insurance in sub-Saharan Africa: what operational difficulties hamper its successful development? Tropical Med Int Health. 2009;14(5):586–96.CrossRef
12.
Dong H, et al. Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso. Health Policy. 2009;92:174–9.CrossRefPubMed
13.
Jütting J. Health insurance for the poor? Determinants of participation in community-based health insurance schemes in rural Senegal. Paris: OECD Development Center; 2003.
14.
De Allegri M, et al. Understanding enrolment in community health insurance in sub-Saharan Africa: a population-based case–control study in rural Burkina Faso. Bull World Health Organ. 2006;84(11):852–8.CrossRefPubMedPubMedCentral
15.
Kimani JK, et al. Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey. BMC Health Serv Res. 2012;12(66):1.
16.
Mladovsky P, et al. Can social capital help explain enrolment (or lack thereof) in community-based health insurance? Results of an exploratory mixed methods study from Senegal. Soc Sci Med. 2014;101:18–27.CrossRefPubMed
17.
Adebayo EF, et al. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries. BMC Health Serv Res. 2015;15(543):1.
18.
Baloul I, Dahlui M. Determinants of health insurance enrolment in Sudan: evidence from Health Utilisation and Expenditure Household Survey 2009. London, BMC Health Services Research 14 (Suppl 2: O17): Evidence-based practice conference, Meeting abstracts; 2014.
19.
Jehu-Appiah C, et al. Household perceptions and their implications for enrolment in the National Health Insurance Scheme in Ghana. Health Policy Plan. 2011;27(3):222–33.CrossRefPubMed
20.
Criel B, Waelkens MP. Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong? Soc Sci Med. 2003;57:1205–19.CrossRefPubMed
21.
De Allegri M, Sanon M, Sauerborn R. ‘‘To enrol or not to enrol?’’ A qualitative investigation of demand for health insurance in rural West Africa. Soc Sci Med. 2006;62:1520–7.CrossRefPubMed
22.
Basaza R, Criel B, Van der Stuyft P. Low enrolment in Ugandan community health insurance schemes: underlying causes and policy implications. BMC Health Serv Res. 2007;7(105):1.
23.
Mathauer I, Schmidt J-O, Wenyaa M. Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand. Int J Health Plan Manag. 2008;23:51–68.CrossRef
24.
Mebratie AD, et al. Dropping out of Ethiopia’s community-based health insurance scheme. Health Policy Plan. 2015;30(10):1296–306.CrossRefPubMed
25.
Atinga RA, Abiiro GA, Kuganab-Lem RB. Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana. Trop Med Int Health. 2015;20(3):312–21.CrossRefPubMed
26.
Jehu-Appiah C, et al. Equity aspects of the National Health Insurance Scheme in Ghana: who is enrolling, who is not and why? Soc Sci Med. 2011;72:157–65.CrossRefPubMed
27.
Odeyemi IA. Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration. Int J Equity Health. 2014;13(20):1.
28.
Buchmueller TC, Gilmer T, Harris K. Health plan disenrollment in a choice-based Medicaid managed care program. Inquiry, 41(Winter 2004/2005); 2004. p. 447–460.
29.
30.
Kjellgren A, et al. Sudan social safety net assessment. Washington DC: The World Bank; 2014.
31.
32.
33.
34.
35.
NHIF. NHIF report—Kassala state. Khartoum: NHIF; 2012.
36.
Fakihammed WA. Determinants of informal sector participation in the National Health Insurance Fund in Kassala State (Eastern Sudan), unpublished MSc thesis, Chulalongkorn University, Bangkok; 2014.
37.
NHIF. Annual statistical report—Kassala. Khartoum: NHIF; 2011.
38.
Yamane T. Statistics: an introductory analysis. 2nd ed. New York: Harper and Row; 1967.
39.
40.
41.
Asadi-Lari M, Tamburini M, Gray D. Patients’ needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes. 2004;2(32):1.
42.
Rajkotia Y, Frick K. Does household enrolment reduce adverse selection in a voluntary health insurance system? Evidence from the Ghanaian National Health Insurance System. Health Policy Plan. 2011;27(5):1–9.
Metadata
Title
Determinants of Voluntary National Health Insurance Drop-Out in Eastern Sudan
Authors
Chantal Herberholz
Wael Ahmed Fakihammed
Publication date
01-04-2017
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 2/2017
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-016-0281-y

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