Parmar, D.

Sauerborn, R.

Savadogo, G.

Souares, A.

City Research Online

Parmar, D., Souares, A., Savadogo, G. & Sauerborn, R. (2010). Does community-based health insurance protect household assets?. Paper presented at the 9th International Conference on Health Economics, Management and Policy, 28-06-2010 - 01-07-2010, Athens, Greece. City Research OnlineOriginal citation: Parmar, D., Souares, A., Savadogo, G. & Sauerborn, R. (2010). Does community-based health insurance protect household assets?. Paper presented at the 9th International Conference on Health Economics, Management and Policy, 28-06-2010 - 01-07-2010, Athens, Greece. Permanent City Research Online URL: http://openaccess.city.ac.uk/4135/ Copyright & reuseCity University London has developed City Research Online so that its users may access the research outputs of City University London's staff. Copyright © and Moral Rights for this paper are retained by the individual author(s) and/ or other copyright holders.  All material in City Research Online is checked for eligibility for copyright before being made available in the live archive. URLs from City Research Online may be freely distributed and linked to from other web pages. Versions of researchThe version in City Research Online may differ from the final published version. Users are advised to check the Permanent City Research Online URL above for the status of the paper.EnquiriesIf you have any enquiries about any aspect of City Research Online, or if you wish to make contact with the author(s) of this paper, please email the team at publications@city.ac.uk.Does community-based health insurance protect household assets?1Institute of Public HealthHeidelberg UniversityGermany2Nouna Health Research CentreBurkina FasoDivya Parmar1,AuréliaSouares1, Germain Savadogo2, Rainer Sauerborn1Burkina Faso• Population:  14.4 million• GNI per capita (PPP): $1,130 (207/228)• Occupation: 90% engaged in agriculture• Spending on health per person: $7• Life expectancy m/f (years):  46/49 (199/228)• Infant mortality rate:  85 /1000 live births• No. of people per doctor: 33,333Reference: WHO (2006)  Community-based health insurance− Introduced in 2004− Unit of enrolment is the household− Premium: 1500 CFA (2.29€) adult 500 CFA (0.76€)childCommunity-based health insurancePremiumAccess to health careCapitation• Managed by the community • Health risk-sharing and pooling of resources at community level• Aims:− Facilitate access to care− Provide financial protection against the cost of illness	 						Research QuestionDoes CBHI protect household assets in the Nouna Health District? 										 		 !			""				#	#						"$Observational dataUnlike randomized trials, in observational studies the intervention (CBHI) is notrandomized…Enrolment for CBHI is voluntary: we cannot assume that the insured (cases) and uninsured (controls) are similar Selection biasHousehold assetsCBHIunobserved variablesHousehold assetsCBHIReverse (2-way) causationInstrumental variable (IV) IVHousehold assetsCBHI(Exclusion restriction)(Relevance)1. Instrumental Variable (IV) ModelEligibility HH assetsCBHI(Exclusion restriction)(Relevance)• Study area divided into 31 clusters• CBHI offered randomly - 2004: 11 clusters- 2005: +9 clusters (11+9=20)- 2006: +11 clusters (20+11=31)2. Fixed Effects (FE) Model• Entire period: 2004-2007• Does not control for 2-way causalityHH assetsCBHIunobserved variablesSelection bias"						%	&	&	Models"			'#ModelHH assetsit+1= Zi.β1 + Xit.β2 + nCBHIit. β3 + ui+ εit + δtPer capita HH assetsit+1:Monetary value of livestock and goods/HH sizeZi: observable time-invariant factors e.g. religion, educationXit: observable time varying factors e.g. age, HH size, chronicnCBHIit: number of insured people in the household ui: unobservable time-invariant factors e.g. ability, preferenceεit: household-specific time shock e.g. death in the householdδt: sample-specific time shock e.g. drought that effects everyone(	)*Data sources1. Nouna Health District Household Survey (NHDHS)– DSS region: 41 villages & Nouna town– 15% of the population (Total population:67,262)– Panel survey (same households interviewed every year)– Conducted every year since 2000(0) Socio-demographic: ethnicity, religion, housing conditions, education…(1) Socio-economic: ownership of household goods and livestock…(2) Self-reported morbidity: illness episodes, health-seeking behaviour…(3) Preventive care (4) Risk-sharing  &perceptions on quality of health care(5) CBHI: enrolment decisions, reasons for enrolling…RESULTS00.10.20.30.40.50.60.745,00050,00055,00060,00065,00070,00075,00080,000N=835 N=782 N=776 N=7512004 2005 2006 2007CFAHH assets per capita and insurance variables2004-2007Mean  value of HH assets per capita (CFA)Mean number of insured individuals in the HHMean number of insured HHsDescriptive statistics!+ 	Results: Instrumental Variable (IV) Modelfor 2004-2005Variables Co-efficient Robust SE P-valueInsurance 0.222 0.121 0.070Education 0.273 0.082 0.001Male -0.374 0.106 0.000Year_2005 -0.192 0.035 0.000No. of clusters 31No. of observations 1,588Angrist-Pischke 1st stage chi2 17.33 (p=0.0000)Angrist-Pischke 1st stage F statistic 16.47 (p=0.0003)Notes: 1. Only variables significant at less than 10% significant level are shown here2. Model controls for-Household head characteristics: Ethnicity, Education, Gender, Age, Occupation, -Household characteristics: Size, Chronic, Eligible-Village characteristics: Town, Literacy, Water source, Distance, Health facility-Year dummies',-./(		0Results: Fixed Effects (FE) Modelfor 2004-2007Variables Co-efficient Robust SE P-valueInsurance 0.009 0.005 0.082Size -0.125 0.049 0.010Year_2005 -0.157 0.027 0.000Year_2006 -0.085 0.031 0.006Year_2007 0.124 0.034 0.000No. of clusters 890No. of observations 3,144Notes: 1. Only variables significant at less than 10% significant level are shown here2. Only time varying variables are included-Household head characteristics: Age -Household characteristics: Size, Chronic-Village characteristics: Town, Water source, Distance-Year dummies1/00.10.20.30.40.50.60.745,00050,00055,00060,00065,00070,00075,00080,000N=835 N=782 N=776 N=7512004 2005 2006 2007CFAHH assets per capita and insurance variables2004-2007Mean  value of HH assets per capita (CFA)Mean number of insured individuals in the HHMean number of insured HHsConclusionBoth models: CBHI protects household assets(2',-./ )*21/(-Thank youAny questions, comments …

Does community-based health insurance protect household assets?

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