Factors Influencing Low Enrollment in a Community Based Health Insurance Scheme, Karachi, Pakistan: a Mixed Methods Case Study
Keywords:Community Based Health Insurance; Out of Pocket expenditure; Healthcare Financing; Safety Nets; Pakistan
Background: There is strong evidence on the potential of the Community Based Health Insurance (CBHI) schemes to facilitate access to healthcare and offer financial protection against the cost of illness for people excluded from formal insurance systems. However, enrollment in the Family Health Insurance scheme has remained low and there has been substantial dropout from the initial enrollment of the scheme’s insured members.
Aim:This research aimed at exploring factors influencing enrollment of community members in a CBHI scheme.
Methods:A mixed methods case studycomprisingqualitative phase of 10 Key Informant Interviews and 18 In-depth Interviews, and quantitative phase of 190 households: 96 insured and 94 uninsured were involved. Qualitative analysis was done using open coding while descriptive analysis was done for quantitative data.
Results:Lack of awareness regarding insurance, lack of trust in management, unaffordability of insurance premiums, limited coverage of services in insurance plans, ambiguity regarding pre-existing conditions, negative marketing by drop-outs, and exclusion of vulnerable groups were some of the common reasons among uninsured group. Insured members of the scheme also had little knowledge about the scheme.
Conclusions:The major reason for enrollment was the influence of community leader’s guidance. Stakeholders believed in modification of marketing strategies and innovations in increasing community awareness.
Bangladesh Journal of Medical Science Vol.20(2) 2021 p.293-301
How to Cite
Authors who publish in the Bangladesh Journal of Medical Science agree to the following terms that:
- Authors retain copyright and grant Bangladesh Journal of Medical Science the right of first publication of the work.
Articles in Bangladesh Journal of Medical Science are licensed under a Creative Commons Attribution 4.0 International License CC BY-4.0.This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Authors are able to enter into separate, additional contractual arrangements for the distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted to post their work online (e.g., in institutional repositories or on their website) as it can lead to productive exchanges, as well as greater citation of published work.