Equity in community health insurance schemes: evidence and lessons from Armenia

Polonsky, J and Balabanova, D and McPake, Barbara and Poletti, T and Vyas, S and Ghazaryan, O and Yanni, MK (2009) Equity in community health insurance schemes: evidence and lessons from Armenia. Health Policy and Planning, 24 (3). pp. 209-216. ISSN 02681080


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Official URL: http://dx.doi.org/10.1093/heapol/czp001


Introduction Community health insurance (CHI) schemes are growing in importance in lowincome settings, where health systems based on user fees have resulted in significant barriers to care for the poorest members of communities. They increase revenue, access and financial protection, but concerns have been expressed about the equity of such schemes and their ability to reach the poorest. Few programmes routinely evaluate equity impacts, even though this is usually a key objective. This lack of evidence is related to the difficulties in collecting reliable data on utilization and socio-economic status. This paper describes the findings of an evaluation of the equity of Oxfam?s CHI schemes in rural Armenia. Methods Members of a random sample of 506 households in villages operating insurance schemes in rural Armenia were interviewed using a structured questionnaire. Household wealth scores based on ownership of assets were generated using principal components analysis. Logistic and Poisson regression analyses were performed to identify the determinants of health facility utilization, and equity of access across socio-economic strata. Results The schemes have achieved a high level of equity, according to socio-economic status, age and gender. However, although levels of participation compare favourably with international experience, they remain relatively low due to a lack of affordability and a package of primary care that does not include coverage for chronic disease. Conclusion This paper demonstrates that the distribution of benefits among members of this community-financing scheme is equitable, and that such a degree of equity in community insurance can be achieved in such settings, possibly through an emphasis on accountability and local management. Such a scheme presents a workable model for investing in primary health care in resource-poor settings.

Item Type: Article
Uncontrolled Keywords: Armenia; Community-based health insurance; Equity; Former Soviet Union; Health care utilization
Divisions: School of Health Sciences > The Institute for Global Health and Development
Date Deposited: 20 Jun 2009 10:28
Last Modified: 02 Feb 2017 15:38
URI: http://eresearch.qmu.ac.uk/id/eprint/607


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