David M. Dror|Shahed Hossain|Atanu Majumdar|Tracey Koehlmoos|Denny John|Pradeep Kumar Panda
What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis
Erasmus University Rotterdam|Micro Insurance Academy|International Centre for Diarrhoeal Disease Research|Micro Insurance Academy|Uniformed Services University of the Health Sciences|International Management Institute
research article reports factors influencing initial voluntary uptake communitybased health insurance cbhi schemes low middleincome countries lmic renewal decisionsfollowing prisma protocol conducted comprehensive search academic gray literature including academic databases social science economics medical sciences eg econlit global health medline proquest electronic resources eg eldis google scholar search strategies developed using thesaurus index terms eg mesh specific databases combined free text terms related cbhi health insurance searches conducted may 2013 november 2013 english french german spanish initial search yield 15770 hits 54 relevant studies retained analysis factors influencing enrolment renewal decisions quantitative synthesis informed metaanalysis qualitative analysis informed thematic synthesis compared gain insight overall synthesis findingsstatementsmetaanalysis suggests enrolments cbhi positively associated household income education age household head hhh household size femaleheaded household married hhh chronic illness episodes household thematic synthesis suggests following factors enablers enrolment knowledge understanding insurance cbhi b quality healthcare c trust scheme management factors found barriers enrolment include inappropriate benefits package b cultural beliefs c affordability distance healthcare facility e lack adequate legal policy frameworks support cbhi f stringent rules cbhi schemes hhh education household size trust scheme management positively associated member renewal decisions motivators knowledge understanding insurance cbhi b healthcare quality c trust scheme management receipt insurance payout previous year barriers renewal decisions stringent rules cbhi schemes b inadequate legal policy frameworks support cbhi c inappropriate benefits packagethe demandside factors positively affecting enrolment cbhi include education age female household heads socioeconomic status households moreover individuals understand cbhi functions likely enroll people positive claims experience likely renew higher prevalence chronic conditions perception healthcare good quality nearby act factors enhancing enrolment perception services distant deficient leads lower enrolments second insight trust scheme enables enrolment thirdly clarity legal policy framework acts factor influencing enrolments significant points hitherto unpublished evidence governments effectively broaden outreach grassroots groups excluded social protection formulating supportive regulatory policy provisions even cannot fund schemes full leveraging peoples willingness exercise voluntary contributory enrolment communitybased health insurance