Rukundo, Emmanuel Nshakira: Effects of community-based health insurance on child health outcomes and utilisation of preventive health services : Evidence from rural south-western Uganda. - Bonn, 2018. - Dissertation, Rheinische Friedrich-Wilhelms-Universität Bonn.
Online-Ausgabe in bonndoc: https://nbn-resolving.org/urn:nbn:de:hbz:5n-52391
@phdthesis{handle:20.500.11811/7371,
urn: https://nbn-resolving.org/urn:nbn:de:hbz:5n-52391,
author = {{Emmanuel Nshakira Rukundo}},
title = {Effects of community-based health insurance on child health outcomes and utilisation of preventive health services : Evidence from rural south-western Uganda},
school = {Rheinische Friedrich-Wilhelms-Universität Bonn},
year = 2018,
month = oct,

note = {With the renewed focus on health for all through universal health coverage, community-based health insurance has been proposed both as a building block for health systems financing and also providing financial protection to poor households that are faced with catastrophic health expenditures in developing countries. Research on these two broad purposes for community-based health insurance has been immense over the last couple of years. However, one area that remains under researched is whether community-based health insurance has any effects beyond these two, and in particular on health outcomes or preventive health practices. The absence of research in this dimension is often attributed to the difficulty of disentangling endogeneity between health insurance and health outcomes. Research presented in this thesis aims to respond to this research gap by studying the impact of community-based health insurance on child health and preventive health practices, using a case study from south-western Uganda. The study answers to three basic questions. (1) What determines enrolment in and continued participation in community-based health insurance in rural south-western Uganda? (2) Does community-based health insurance contribute to stunting reduction? And (3) can community-based health insurance nudge household preventive health practices?
To respond to these questions, a household survey covering 464 households was conducted in Kabale and Rukungiri districts, particularly in regions that are primarily serviced by Kisiizi hospital. Kisiizi hospital runs a community-based health insurance scheme, currently the largest in Uganda. From this data, three analytical chapters responding to three questions are developed. The first analytical chapter (appearing as Chapter Two in the thesis) uses logistic regression methods to understand the drivers of enrolment and continued participation in insurance. The study finds significant positive correlations with household socioeconomic status, knowledge about insurance, and effects of both the number of burial groups in the village that participate in CBHI as well as the size of the burial group a household belonged to. Chapter Three and Chapter Four delve further into causal analysis and utilise novel two-stage residual inclusion instrumental variables and inverse probability weighting estimations respectively. Inverse Probability Weighting facilitates estimation of causal effects after controlling for the observables while the variant of the instrumental variable methods helps us model a combined effect of selection into insurance and insurance intensity measured by the number of years a household has been in CBHI.
Our results indicate that an extra year in CBHI was associated with reducing the probability of child stunting by 5.7 percentage points. This implied that for a child's under-five life span, the probability of stunting could be reduced by 28.5 percentage points due to a household's enrolment in CBHI. In addition we find that the poorest households had a higher rate of reducing the probability of child stunting indicating that CBHI was effective in improving health outcomes of the poorest. In Chapter Four, we focus on seven preventive health strategies and treatments available in rural Uganda. These were water treatment, child deworming, vitamin A supplementation, iron supplementation and use of long lasting insecticide treated mosquito nets, handwashing and receiving the new vaccine for child pneumonia, PCV. Utilising inverse probability weighting of the propensity score, we find significant average treatment effects in four of the seven outcomes measured, namely, using a long lasting insecticide treated mosquito nets, water treatment, iron supplementation and deworming. Moreover, we find significant average treatment effects on the treated on five of the seven outcomes, including receiving of the pneumonia vaccine. By and large, this research adds to the thin layer on CBHI effects on health outcomes and utilisation of preventive health interventions.},

url = {http://hdl.handle.net/20.500.11811/7371}
}

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