Health Insurance for the Poor? Determinants of Participation

Poor people lack access to health care with a negative impact on their dignity, human capital formation and their risk-management options. Recently an emerging movement of community-based health insurance schemes has attracted the attention of policy makers and researchers as it seems that these schemes target the poor more efficiently. Taking the example of community-based health insurance schemes in rural Senegal this paper identifies the factors explaining participation in these schemes. Using household survey data of non-members and members, we found that household income, religion, village characteristics and the belonging to a certain ethnic group exert the strongest influence on the probability of participation. From these findings, it follows that i) although the schemes reach the “poor ” in general, the “poorest of the poor ” within the villages find it financially difficult to participate; ii) social exclusion due to religion or ethnic group might persist. Several options for designing the schemes in order to address these weaknesses are discussed