Skip to main content

Table 2 Framework for analysis of CHI schemes in sub-Saharan Africa

From: Low enrolment in Ugandan Community Health Insurance Schemes: underlying causes and policy implications

Name of the framework Features      
  Typology used Main players Relationship between key players Flow of funds Supply and utilization of care The role of Public Health Authority (PHA)
Arhin-Tenkorang D 2001 Mutual benefit society, provider insurance, mutual partnership and third party insurance External stakeholders (members, suppliers etc); internal stakeholders (employees, managers etc). There is exchange of resources and expectations between stakeholders within the scheme. From subscribing unit to agency/insurance scheme and then provider Presence of manuals, guidelines for quality assurance and contracts between the insurer and provider or client and insurer Supervision of a range of benefits, financing of benefits, instituting and enforcing regulations. Linkages of CHI schemes with the formal financing networks.
Hohmann J et al 2001 Not described External stakeholders, target groups (individual, household or group), insurer or other sub-contracted providers Target group make regular contributions to an insurance scheme. A benefit package is provided by the scheme directly or by contracting other sub-contracted providers. Instead of or in addition to, the scheme, may reimburse claims Funds flow from the target group to the insurance scheme and to the provider. The benefit package is defined by regulations or by requirements of subscribers. The schemes may provide other products like cash benefits, burial and harvest insurance Supervising and regulating of the schemes. Registration/licensing of the insurance schemes. Accreditation guidelines. The PHA may be in favour of the schemes or against, whilst different ministries may have different opinion.
Criel B. 2000 Mutual – provider driven. Subscribing unit, insurer or purchaser and the health care provider. Two explicit relationships: (1)Between the subscribers and insurer. The insurer is an intermediary between the subscriber and the provider or the subscriber may deal with the insurer who may at the same time be the provider (2)Insurer and provider: may have a contract or a convention Three main categories: (1)Contributions which are mainly premiums to the purchaser (2) payment of the provider by the insurer (3) payment to the provider at the time or point of use The content of the package is crucial. There may be other benefits outside the health system such as transport Technical & regulative control, legislative and funding role. Social animation role in line with PHC philosophy
Musau S 1999 2 types of schemes identified: A) Covering high costs, low incidence health care events B) Those with low cost but probability events Members, providers and insurers. Highlights the advantage of enrolling cohesive communities as vehicles for development of CHI. Members pay a premium to providers or mutual organizations which pays the providers Benefit package defined in the guidelines. Policy and legal frame work, a regulatory one and finally technical support
Bennett S, Creese A and Monasch R1998 Two typologies presented. One based on health facility, community, co-operatives or mutual, NGO and Government The second one based cost: Type I: high cost and low frequency events (hospital inpatient care) and Type II: low cost and high frequency (basic primary care). Government, NGO, communities and providers. Membership can be geographical or place of residence or place of work. Individual enrolment is subject to adverse selection. In type 1, premiums are paid to the scheme and the scheme pays the hospital on case-basis or fee per service item. Type II premiums are simply allocated to the nearest provider on a lump sum basis. Benefit package may be available at the facility or published defined lists and or financial ceilings. Provide policy framework and operational guidelines, training of community members in scheme management and ensuring accountability of fund holders. Could provide a subsidy as well.
Shaw R and Ainsworth M 1995 - Nation – wide schemes
- District based Schemes
-Small facility or village based schemes
Members, providers of care and third party. Subscribing unit could be an individual or a family or a household. In order to minimize adverse selection, group insurance should be promoted. Funds are collected during the harvest/high income season to the facility or government. The facility provides the care. Within the pool benefits are provided on the basis of need rather than income. No further elaboration. Not overseen