ArticlePloS one2021
Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Dropout rate and associated factors of community-based health insurance beneficiaries in Ethiopia: a systematic review and meta-analysis.BMC public health · 2023Pooled it
- Investigating membership attrition dynamics in community-based health insurance: a survival analysis of socioeconomic and program-specific determinants in the Amhara Region, Northwest Ethiopia.BMC public health · 2025Article
- Dropout rate from a community-based health insurance scheme and associated factors in the Hagere Mariam district: a mixed method study.Frontiers in public health · 2025Article
- Community-based health insurance dropout rate and its' associated factors among households in Seyo District, Kellem Wollega Zone, Oromia, Ethiopia: community-based cross-sectional study.Frontiers in public health · 2025Article
- Article
- Experiences of membership in munno mubulwadde (your friend indeed) - a novel community-based health insurance scheme in Luwero district in rural central Uganda.BMC health services research · 2024Article
- Factors Related to Client Satisfaction with Community Based Health Insurance Services During COVID-19 Pandemic in Central Uganda: A Mixed Methods Healthcare Facility Based Study.The East African health research journal · 2024Article
- Causes of dropout from health insurance program: An experience from Lumbini Province, Nepal.Dialogues in health · 2023Article
- Whether or not to enroll, and stay enrolled? A Tanzanian cross-sectional study on voluntary health insurance.Health policy OPEN · 2023Article
- Community-Based Health Insurance Utilization and Its Determinants among Informal Workers: Cross-Sectional Study.Ethiopian journal of health sciences · 2023Article
- Pooled coverage of community based health insurance scheme enrolment in Ethiopia, systematic review and meta-analysis, 2016-2020.Health economics review · 2022Review
- Continued adherence to community-based health insurance scheme in two districts of northeast Ethiopia: application of accelerated failure time shared frailty models.International journal for equity in health · 2022Article
- The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia.PloS one · 2022Article
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3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
aimCommunity Based Health Insurance (CBHI) schemes have become central to health systems financing as avenues of achieving universal health coverage in developing countries. Yet, while emphasis in research and policy has mainly concentrated on enrolment, very little has been apportioned to high rates of dropping out after initial enrolment. The main aim of this study is to understand the factors behind CBHI dropping out through a cross-sectional quantitative research design to gain insights into curtailing the drop out of CBHI in Uganda.
methodsThe survey for the quantitative research component took place between August 2015 and March 2016 covering 464 households with under-5 children in south-western Uganda. To understand the factors associated with dropping out of CBHI, we employ a multivariate logistic regression on a subsample of 251 households who were either currently enrolled or had enrolled at one time and later dropped out.
resultsOverall, we find that 25.1 percent of the households that had ever enrolled in insurance reported dropping out. Household socioeconomic status (wealth) was one of the key factors that associated with dropping out. Larger household sizes and distance from the hospital were significantly associated with dropping out. More socially connected households were less likely to drop out revealing the influence of community social capital in keeping households insured.
conclusionThe findings have implications for addressing equity and inclusion concerns in community-based health insurance programmes such as one in south-western Uganda. Even when community based informal system aim for inclusion of the poorest, they are not enough and often the poorest of the poor slip into the cracks and remain uninsured or drop out. Moreover, policy interventions toward curtailing high dropout rates should be considered to ensure financial sustainability of CBHI schemes.
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