The European Journal of Health Economics

, Volume 9, Issue 1, pp 41–50

The differences in characteristics between health-care users and non-users: implication for introducing community-based health insurance in Burkina Faso

  • Hengjin Dong
  • Adjima Gbangou
  • Manuela De Allegri
  • Subhash Pokhrel
  • Rainer Sauerborn
Original paper

Abstract

The purposes of this study are to describe the characteristics of different health-care users, to explain such characteristics using a health demand model and to estimate the price-related probability change for different types of health care in order to provide policy guidance for the introduction of community-based health insurance (CBI) in Burkina Faso. Data were collected from a household survey using a two stage cluster sampling approach. Household interviews were carried out during April and May 2003. In the interviewed 7,939 individuals in 988 households, there were 558 people reported one or more illness episodes; two-thirds of these people did not seek professional care. Health care non-users display lower household income and expenditure, older age and lower perceived severity of disease. The main reason for choosing no-care and self-care was ‘not enough money’. Multinomial logistic regression confirms these observations. Higher household cash-income, higher perceived severity of disease and acute disease significantly increased the probability of using western care. Older age and higher price-cash income ratio significantly increased the probability of no-care or self-care. If CBI were introduced the probability of using western care would increase by 4.33% and the probability of using self-care would reduce by 3.98%. The price-related probability change of using western care for lower income people is higher than for higher income although the quantity changed is relatively small. In conclusion, the introduction of CBI might increase the use of medical services, especially for the poor. Co-payment for the rich might be necessary. Premium adjusted for income or subsidies for the poor can be considered in order to absorb a greater number of poor households into CBI and further improve equity in terms of enrolment. However, the role of CBI in Burkina Faso is rather limited: it might only increase utilisation of western health care by a probability of 4%.

Keywords

Health services Community-based health insurance Burkina Faso Demand Price elasticity 

References

  1. 1.
    Akin, J., Griffin, C., Guilkey, D., Popkin, B.: The demand for adult outpatient services in the Bicol region of the Philippines. Soc. Sci. Med. 22, 321–328 (1986)CrossRefGoogle Scholar
  2. 2.
    Alderman, H., Gertler, P.: Family resources and gender differences in human capital investments. In: Haddad, L., Hoddinott, J., Alderman, H. (eds.) Intrahousehold resource allocation in developing countries, Johns Hopkins Press, Baltimore (1997)Google Scholar
  3. 3.
    Asenso-Okyere, W.K., Osei-Akoto, I., Anum, A., et al.: Willingness to pay for health insurance in a developing economy. A pilot study of the informal sector of Ghana using contingent valuation. Health Policy 42, 223–237 (1997)CrossRefGoogle Scholar
  4. 4.
    Baltussen, R., Yé, Y., Haddad, S., Sauerborn, R.: Perceived quality of care of primary health care services in Burkina Faso. Health Policy Plan. 17, 42–48 (2002)CrossRefGoogle Scholar
  5. 5.
    Burkina Faso Ministry of Health: Statistiques Sanitaires 1996. Burkina Faso Ministry of Health, Ouagadougou (1996)Google Scholar
  6. 6.
    Burkina Faso Ministry of Health: Project de Document de Politique Sanitaire Nationale (PSN). Burkina Faso Ministry of Health, Ouagadougou (2000)Google Scholar
  7. 7.
    Ching, P.: User fees, demand for children’s health care and access across income groups: the Philippine case. Soc. Sci. Med. 41, 37–46 (1995)CrossRefGoogle Scholar
  8. 8.
    Collier, P., Dercon, S., Mackinnon, J.: Density versus quality in health care provision: using household data to make budgetary choices in Ethiopia. World Bank Econ. Rev. 16, 425–448 (2002)CrossRefGoogle Scholar
  9. 9.
    Creese, A., Bennett, S.: Rural risk-sharing strategies. In: George, J., Schieber, (eds.) Innovations in health care financing. World Bank discussion paper no. 365. The World Bank, Washington DC, pp 163–182 (1997)Google Scholar
  10. 10.
    David, S.: Health expenditure and household budgets in rural Liberia. Health Transit. Rev. 3, 57–76 (1993)Google Scholar
  11. 11.
    Dong, H.J., Kouyate, B., Cairns, J., et al.: Willingness to pay for community-based insurance in Burkina Faso. Health Econ. 12, 849–862 (2003)CrossRefGoogle Scholar
  12. 12.
    Dong, H.J., Mugisha, F., Gbangou, A., et al.: The feasibility of community-based health insurance in Burkina Faso. Health Policy 69, 45–53 (2004)CrossRefGoogle Scholar
  13. 13.
    Gertler, P., Locay, L., Sanderson, W.: Are user fees regressive? The welfare implications of health care financing proposals in Peru. J. Econom. 36, 67–88 (1987)CrossRefGoogle Scholar
  14. 14.
    Gertler, P., Molyneaux, J.: Experimental evidence on the effect of raising users fees for publicly delivered health care services: utilization health outcomes, and private provider response. RAND, Santa Monica (1997)Google Scholar
  15. 15.
    Gertler, P., van der Gaag, J.: The willingness to pay for medical care. Johns Hopkins University Press, Baltimore (1990)Google Scholar
  16. 16.
    Greene, W.H.: Econometric Analysis. Prentice Hall International, Inc., New Jersey (1997)Google Scholar
  17. 17.
    Grossman, M.: On the concept of health capital, the demand for health. J. Polit. Econ. 80, 223–255 (1972)CrossRefGoogle Scholar
  18. 18.
    Hausman, J., McFadden, D.: Specification tests for the multinomial logit model. Econometrica 52(5), 1219–1240 (1984)CrossRefGoogle Scholar
  19. 19.
    Heller, P.: A model of the demand for medical and health services in Penisular Malaysia. Soc. Sci. Med. 16, 267–284 (1982)CrossRefGoogle Scholar
  20. 20.
    Hidayat, B., Thabrany, H., Dong, H., Sauerborn, R.: The effects of mandatory health insurance on equity in access to outpatient care in Indonesia. Health Policy Plan. 19, 322–335 (2004)CrossRefGoogle Scholar
  21. 21.
    Jütting, J.P.: Do community-based health insurance schemes improve poor people’s access to health care? Evidence from rural Senegal. World Dev. 32, 273–288 (2004)CrossRefGoogle Scholar
  22. 22.
    Krause, G., Schleiermacher, D., Borchert, M., et al.: Diagnostic quality in rural health centres in Burkina Faso. Trop. Med. Int. Health 3, 100–107 (1998)CrossRefGoogle Scholar
  23. 23.
    Mwabu, G.M.: Health care decisions at the household level: results of a rural health survey in Kenya. Soc. Sci. Med. 22, 315–319 (1986)CrossRefGoogle Scholar
  24. 24.
    Phelps, C.E.: Health Economics. Harper Collins, New York (1992)Google Scholar
  25. 25.
    Pokhrel, S.: Role of price, income and gender on the demand for child health care in Nepal. University of Heidelberg (dissertation) (2004)Google Scholar
  26. 26.
    Pokhrel, S., Snow, R., Dong, H., Hidayat, B., Flessa, S., Sauerborn, R.: Gender role and child health care utilization in Nepal. Health Policy 74, 100–109 (2005)CrossRefGoogle Scholar
  27. 27.
    Sankoh, O.A., Ye, Y., Sauerborn, R., et al.: Clustering of childhood mortality in rural Burkina Faso. Int. J. Epidemiol. 30, 485–492 (2001)CrossRefGoogle Scholar
  28. 28.
    Sauerborn, R., Berman, P., Nougtara, A.: Age bias, but no gender bias, in the intra-household resource allocation for health care in rural Burkina Faso. Health Transit. Rev. 6, 131–145 (1996)Google Scholar
  29. 29.
    Sauerborn, R., Nougtara, A., Diesfeld, H.J.: Low utilisation of community health workers: results from a household interview survey in Burkina Faso. Soc. Sci. Med. 29, 1163–1174 (1989)CrossRefGoogle Scholar
  30. 30.
    Sauerborn, R., Nougtara, A., Latimer, E.: The elasticity of demand for health care in Burkina Faso: differences across age and income groups. Health Policy Plan. 9, 185–192 (1994)CrossRefGoogle Scholar
  31. 31.
    Sauerborn, R., Nougtara, A., Hien, M., et al.: Seasonal variations of household costs of illness in Burkina Faso. Soc. Sci. Med. 43, 281–290 (1996)CrossRefGoogle Scholar
  32. 32.
    Sauerborn, R., Nougtara, A., Sorgho, G., et al.: Assessment of MCH services in the district of Solenzo, Burkina Faso. II. Acceptability. J. Trop. Pediatr. 35(Suppl 1), 10–13 (1989)Google Scholar
  33. 33.
    Schwartz, J., Akin, J., Popkin, B.: Price and income elasticities of demand for modern health care: the case of infant delivery in the Philippines. World Bank Econ. Rev. 2, 49 (1988)CrossRefGoogle Scholar
  34. 34.
    StataCorp.: Stata Statistical Software: Release 7.0. Stata Corporation, College Station Texas (2001)Google Scholar
  35. 35.
    van de Ven, W., van Pragg, B.: The demand for deductibles in private health insurance: a probit model with sample selection. J. Econom. 17, 229–252 (1981)CrossRefGoogle Scholar
  36. 36.
    Waters, H.R.: Measuring the impact of health insurance with a correction for selection bias—a case study of Ecuador. Health Econ. 8, 473–483 (1999)CrossRefGoogle Scholar
  37. 37.
    World Bank.: African Development Indicators 2000. World Bank, Washington DC (2000)Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Hengjin Dong
    • 1
    • 3
  • Adjima Gbangou
    • 2
  • Manuela De Allegri
    • 1
  • Subhash Pokhrel
    • 4
  • Rainer Sauerborn
    • 1
  1. 1.Department of Tropical Hygiene and Public HealthUniversity of HeidelbergHeidelbergGermany
  2. 2.Nouna Health Research CentreNounaBurkina Faso
  3. 3.Health Economics Research GroupBrunel UniversityUxbridgeUK
  4. 4.School of Health Sciences and Social CareBrunel UniversityUxbridgeUK

Personalised recommendations