title: Econometric analysis to evaluate the effect of community-based health insurance on reducing informal self-care in Burkina Faso.
abstract: OBJECTIVE
  This study examines the role of community-based health insurance (CBHI) in influencing health-seeking behaviour in Burkina Faso, West Africa. Community-based health insurance was introduced in Nouna district, Burkina Faso, in 2004 with the goal to improve access to contracted providers based at primary- and secondary-level facilities. The paper specifically examines the effect of CBHI enrolment on reducing the prevalence of seeking modern and traditional methods of self-treatment as the first choice in care among the insured population.
  
  
  METHODS
  Three stages of analysis were adopted to measure this effect. First, propensity score matching was used to minimize the observed baseline differences between the insured and uninsured populations. Second, through matching the average treatment effect on the treated, the effect of insurance enrolment on health-seeking behaviour was estimated. Finally, multinomial logistic regression was applied to model demand for available health care options, including no treatment, traditional self-treatment, modern self-treatment, traditional healers and facility-based care.
  
  
  RESULTS
  For the first choice in care sought, there was no significant difference in the prevalence of self-treatment among the insured and uninsured populations, reaching over 55% for each group. When comparing the alternative option of no treatment, CBHI played no significant role in reducing the demand for self-care (either traditional or modern) or utilization of traditional healers, while it did significantly increase consumption of facility-based care. The average treatment effect on the treated was insignificant for traditional self-care, modern self-care and traditional healer, but was significant with a positive effect for use of facility care.
  
  
  CONCLUSIONS
  While CBHI does have a positive impact on facility care utilization, its effect on reducing the prevalence of self-care is limited. The policy recommendations for improving the CBHI scheme's responsiveness to population health care demand should incorporate community-based initiatives that offer attractive and appropriate alternatives to self-care.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA. jakerobyn@gmail.com
authors.forename: Paul Jacob
authors.initials: PJ
authors.lastname: Robyn
authors.forename: Allan
authors.initials: A
authors.lastname: Hill
authors.forename: Yuanli
authors.initials: Y
authors.lastname: Liu
authors.forename: Aurélia
authors.initials: A
authors.lastname: Souares
authors.forename: Germain
authors.initials: G
authors.lastname: Savadogo
authors.forename: Ali
authors.initials: A
authors.lastname: Sié
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000293:Adolescent; D000328:Adult; D002050:Burkina Faso; D019058:Community Networks; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008297:Male; D016488:Medicine, African Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D017059:Models, Econometric; D012648:Self Care / Q000706:statistics & numerical data*; D055815:Young Adult