Mandatory membership of community-based mutual health insurance in Senegal: A national survey

Valéry Ridde (), Ibrahima Gaye, Bruno Ventelou (), Elisabeth Paul () and Adama Faye
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Valéry Ridde: CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité
Ibrahima Gaye: UCAD - Université Cheikh Anta Diop de Dakar [Sénégal]
Bruno Ventelou: AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique
Elisabeth Paul: ULB - Université libre de Bruxelles
Adama Faye: UCAD - Université Cheikh Anta Diop de Dakar [Sénégal]

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Abstract: With the low adherence to voluntary mutual health insurance, Senegal's policymakers have sought to understand the feasibility of compulsory health insurance membership. This study aims to measure the acceptability of mandatory membership in community-based mutual health insurance (CBHI) and to understand its possible administrative modalities. The study consists of a national survey among a representative population sample selected by marginal quotas. The survey was conducted in 2022 over the phone, with a random composition method involving 914 people. The questionnaire measured the socio-economic characteristics of households, their level of acceptability concerning voluntary and compulsory membership, and their level of confidence in CBHIs and the health system. Respondents preferred voluntary (86%) over mandatory (70%) membership of a CBHI. The gap between voluntary and compulsory membership scores was smaller among women (p = 0.040), people under 35 (p = 0.033), and people with no health coverage (p = 0.011). Voluntary or compulsory membership was correlated (p = 0.000) to trust in current CBHIs and health systems. Lack of trust in the CBHI management has been more disadvantageous for acceptance of the mandatory than the voluntary membership. No particular preference emerged as the preferred administrative channel (e.g. death certificate, identity card, etc.) to enforce the mandatory option. The results confirmed the well-known challenges of building universal health coverage based on CBHIs—a poorly appreciated model whose low performance reduces the acceptability of populations to adhere to it, whether voluntary or mandatory. Suppose Senegal persists in its health insurance approach. In that case, it will be essential to strengthen the performance and funding of CBHIs, and to gain population trust to enable a mandatory or more systemic membership.

Date: 2023
New Economics Papers: this item is included in nep-hea and nep-inv
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Published in PLOS Global Public Health, 2023, 3 (9), pp.e0001859. ⟨10.1371/journal.pgph.0001859⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-04222420

DOI: 10.1371/journal.pgph.0001859

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