Chirwa, Gowokani, Moreno Serra, Rodrigo orcid.org/0000-0002-6619-4560 and Suhrcke, Marc orcid.org/0000-0001-7263-8626 (2020) Socioeconomic Inequality in Premiums for a Community Based Health Insurance Scheme in Rwanda. Health Policy and Planning. ISSN 1460-2237
Abstract
Community Based Health Insurance (CBHI) has gained popularity in many low-and middle-income countries, partly as a policy response to calls for low-cost, pro-poor health financing solutions. In Africa, Rwanda has successfully implemented two types of CBHI systems since 2005, one of which with a flat rate premium (2005-2010) and the other with a stratified premium (2011 –present). Existing CBHI evaluations have, however, tended to ignore the potential distributional aspects of the household contributions made toward CBHI. In this paper, we investigate the pattern of socioeconomic inequality in CBHI household premium contributions in Rwanda within the implementation periods. We also assess gender differences in CBHI contributions. Using the 2010/11 and 2013/14 rounds of national survey data, we quantify the magnitude of inequality in CBHI payments, decompose the concentration index of inequality, calculate Kakwani indices and implement unconditional quantile regression decomposition to assess gender differences in CBHI expenditure. We find that the CBHI with stratified premiums is less regressive than CBHI with a flat rate premium system. Decomposition analysis indicates that income and CBHI stratification explain a large share of the inequality in CBHI payments. With respect to gender, female-headed households make lower contributions toward CBHI expenditure, compared to male-headed households. In terms of policy implications, the results suggest that there may be a need for increasing the premium bracket for the wealthier households, as well as for the provision of more subsidies to vulnerable households.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details. |
Dates: |
|
Institution: | The University of York |
Academic Units: | The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) The University of York > Faculty of Social Sciences (York) > Economics and Related Studies (York) |
Depositing User: | Pure (York) |
Date Deposited: | 15 Sep 2020 11:20 |
Last Modified: | 17 Mar 2025 00:08 |
Published Version: | https://doi.org/10.1093/heapol/czaa135 |
Status: | Published online |
Refereed: | Yes |
Identification Number: | 10.1093/heapol/czaa135 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:165587 |
Downloads
Filename: Manuscript_clean_07092020.docx
Description: Manuscript_clean_07092020
Filename: HEAPOL_2020_Mar_0161.R2_Proof_hi_1_.pdf
Description: HEAPOL-2020-Mar-0161.R2_Proof_hi (1)