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Health Policy and Planning Advance Access originally published online on May 14, 2008
Health Policy and Planning 2008 23(4):264-276; doi:10.1093/heapol/czn011
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2008; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Impact of mutual health organizations: evidence from West Africa

Slavea Chankova*, Sara Sulzbach and François Diop

Abt Associates, Bethesda, MD, USA.

*Corresponding author. International Health Division, Abt Associates, Inc., 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, USA. Tel: +1 301 347 5000. Fax: +1 301 828 9573. E-mail: slavea_chankova{at}abtassoc.com

Mutual health organizations (MHOs) are voluntary membership organizations providing health insurance services to their members. MHOs aim to increase access to health care by reducing out-of-pocket payments faced by households. We used multiple regression analysis of household survey data from Ghana, Mali and Senegal to investigate the determinants of enrolment in MHOs, and the impact of MHO membership on use of health care services and on out-of-pocket health care expenditures for outpatient care and hospitalization. We found strong evidence that households headed by women are more likely to enrol in MHOs than households headed by men. Education of the household head is positively associated with MHO enrolment. The evidence on the association between household economic status and MHO enrolment indicates that individuals from the richest quintiles are more likely to be enrolled than anyone else. We did not find evidence that individuals from the poorest quintiles tend to be excluded from MHOs.

MHO members are more likely to seek formal health care in Ghana and Mali, although this result was not confirmed in Senegal. While our evidence on whether MHO membership is associated with higher probability of hospitalization is inconclusive, we find that MHO membership offers protection against the potentially catastrophic expenditures related to hospitalization. However, MHO membership does not appear to have a significant effect on out-of-pocket expenditures for curative outpatient care.

Key Words: Community health financing, health insurance, mutual health organizations, financial protection

Accepted for publication 26 March 2008.


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