What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries?...

Area of Science:

• Health Economics
• Public Health Policy
• Social Insurance

Background:

• Community-based health insurance (CBHI) schemes are crucial for extending health coverage in low- and middle-income countries (LMICs).
• Understanding factors influencing voluntary enrollment and renewal is vital for scheme sustainability and effectiveness.

Purpose of the Study:

• To identify and synthesize factors affecting initial voluntary uptake of CBHI schemes.
• To analyze factors influencing the renewal decisions of CBHI members.

Main Methods:

• A systematic literature review following PRISMA protocol.
• Comprehensive search of academic and gray literature across multiple databases.
• Quantitative (meta-analysis) and qualitative (thematic synthesis) analyses.

Main Results:

• Positive enrollment factors include higher income, education, age, household size, female headship, and chronic illness. Trust, understanding, and perceived healthcare quality enable enrollment.
• Barriers include affordability, inappropriate benefits, distance, cultural beliefs, and weak policy frameworks.
• Renewal is positively associated with education, household size, trust, understanding, perceived healthcare quality, and positive claims experience.

Conclusions:

• Demand-side factors like education and socioeconomic status significantly impact CBHI enrollment.
• Understanding scheme function, positive claims experiences, perceived healthcare quality, and trust are key drivers for enrollment and renewal.
• Supportive legal and policy frameworks are critical for governments to expand social protection through CBHI, even with limited funding.