title: Impact of mutual health organizations: evidence from West Africa.
abstract: Mutual health organizations (MHOs) are voluntary membership organizations providing health insurance services to their members. MHOs aim to increase access to health care by reducing out-of-pocket payments faced by households. We used multiple regression analysis of household survey data from Ghana, Mali and Senegal to investigate the determinants of enrollment in MHOs, and the impact of MHO membership on use of health care services and on out-of-pocket health care expenditures for outpatient care and hospitalization. We found strong evidence that households headed by women are more likely to enroll in MHOs than households headed by men. Education of the household head is positively associated with MHO enrollment. The evidence on the association between household economic status and MHO enrollment indicates that individuals from the richest quintiles are more likely to be enrolled than anyone else. We did not find evidence that individuals from the poorest quintiles tend to be excluded from MHOs. MHO members are more likely to seek formal health care in Ghana and Mali, although this result was not confirmed in Senegal. While our evidence on whether MHO membership is associated with higher probability of hospitalization is inconclusive, we find that MHO membership offers protection against the potentially catastrophic expenditures related to hospitalization. However, MHO membership does not appear to have a significant effect on out-of-pocket expenditures for curative outpatient care.
authors.affiliation: International Health Division, Abt Associates, Inc., 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, USA. slavea_chankova@abtassoc.com
authors.forename: Slavea
authors.initials: S
authors.lastname: Chankova
authors.forename: Sara
authors.initials: S
authors.lastname: Sulzbach
authors.forename: François
authors.initials: F
authors.lastname: Diop
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003153:Community Health Services / Q000191:economics* / Q000706:statistics & numerical data; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003431:Cross-Cultural Comparison; D005191:Family Characteristics; D005249:Fees and Charges; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005869:Ghana; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008302:Mali; D012044:Regression Analysis; D012675:Senegal