Effects of a free health insurance programme for the poor on health service utilisation and financial protection in Senegal
type: Article
item type: journalArticle
is part of: BMJ Global Health
authors: Person
  surname: Bousmah
  given name: Marwân-Al-Qays
authors: Person
  surname: Diakhaté
  given name: Pathé
authors: Person
  surname: Toulao
  given name: Grâce À Dieu
authors: Person
  surname: Le Hesran
  given name: Jean-Yves
authors: Person
  surname: Lalou
  given name: Richard
subject: health economics
subject: health insurance
subject: health policy
subject: health services research
subject: maternal health
abstract: INTRODUCTION: Implemented in 2013 in Senegal, the Programme National de Bourses de Sécurité Familiale (PNBSF) is a national cash transfer programme for poor households. Besides reducing household poverty and encouraging children's school attendance, an objective of the PNBSF is to expand health coverage by guaranteeing free enrolment in community-based health insurance (CBHI) schemes. In this paper, we provide the first assessment of the PNBSF free health insurance programme on health service utilisation and health-related financial protection. METHODS: We collected household-level and individual-level cross-sectional data on health insurance in 2019-2020 within the Niakhar Population Observatory in rural Senegal. We conducted a series of descriptive analyses to fully describe the application of the PNBSF programme in terms of health coverage. We then used multivariate logistic and Poisson regression models within an inverse probability weighting framework to estimate the effect of being registered in a CBHI through the PNBSF-as compared with having no health insurance or having voluntarily enrolled in a CBHI scheme-on a series of outcomes. RESULTS: With the exception of health facility deliveries, which were favoured by free health insurance, the PNBSF did not reduce the unmet need for healthcare or the health-related financial risk. It did not increase individuals' health service utilisation in case of health problems, did not increase the number of antenatal care visits and did not protect households against the risk of forgoing medical care and of catastrophic health expenditure. CONCLUSION: We found limited effects of the PNBSF free health insurance on health service utilisation and health-related financial protection, although these failures were not necessarily due to the provision of free health insurance per se. Our results point to both implementation failures and limited programme outcomes. Greater commitment from the state is needed, particularly through…
date: 2022-12
pages: e009977
citation key: bousmahEffectsFreeHealth2022
PMID: 36526298
language: eng
library catalog: PubMed
description: WOS:000899365000002

BMJ Global Health
type: Journal
volume: 7
number: Suppl 9
alternative: BMJ Glob Health
identifier: DOI 10.1136/bmjgh-2022-009977
identifier: ISSN 2059-7908