title: Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso.
abstract: OBJECTIVE
  This study aims to identify the reasons why enrolled people decide not to renew their membership in following years.
  
  
  METHODS
  Household survey is used to collect information on the factors influencing dropping out from community-based health insurance (CBI). Information from CBI agency databank is used to describe the general situation of enrolment and drop-out.
  
  
  RESULTS
  Since the launch of CBI the enrolment rate has been low ranging from 5.2% to 6.3%. The drop-out rate, however, has been high ranging from 30.9% to 45.7%. It is found, by the multivariate analysis, that female household head, higher age or lower education of a household head, lower number of illness episodes in the past three months, fewer children or elderly in a household, poor perceived health care quality, less seeking care in the past month positively effected on drop-out, increasing the rate. However, the household six-month expenditure and the distance to the contracted health facility did not have the hypothesised sign. In contrast, a higher household expenditure and a shorter distance to the contracted health facility increased the drop-out.
  
  
  CONCLUSIONS
  High drop-out rates endanger the sustainability of CBI not only because they reduce the size of the insurance pool, but also because they bear a negative impact on further enrolment and drop-out. The drop-out rate in the scheme of the Nouna Health District, Burkina Faso, is very high. The reasons for drop-out may be related to affordability, health-needs and health demand, quality of care, household head and household characteristics. This study represents a valuable attempt towards further increasing the sustainability of CBI schemes, by understanding not what motivates people to first enrol in CBI, but what motivates them to renew membership year after year.
authors.affiliation: Department of Tropical Hygiene and Public Health, University of Heidelberg, INF 324, D-69120 Heidelberg, Germany. dong@uni-heidelberg.de
authors.forename: Hengjin
authors.initials: H
authors.lastname: Dong
authors.forename: Manuela
authors.initials: M
authors.lastname: De Allegri
authors.forename: Devendra
authors.initials: D
authors.lastname: Gnawali
authors.forename: Aurélia
authors.initials: A
authors.lastname: Souares
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002050:Burkina Faso; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data; D012111:Residence Characteristics; D011795:Surveys and Questionnaires