title: Feasibility of community-based health insurance in rural tropical Ecuador.
abstract: OBJECTIVE
  The main objective of this study was to assess people's willingness to join a community-based health insurance (CHI) model in El Páramo, a rural area in Ecuador, and to determine factors influencing this willingness. A second objective was to identify people's understanding and attitudes toward the presented CHI model.
  
  
  METHODS
  A cross-sectional survey was carried out using a structured questionnaire. Of an estimated 829 households, 210 were randomly selected by two-stage cluster sampling. Attitudes toward the scheme were assessed. Information on factors possibly influencing willingness to join was collected and related to the willingness to join. To gain an insight into a respondent's possible ability to pay, health care expenditure on the last illness episode was assessed. Feasibility was defined as at least 50% of household heads willing to join the scheme.
  
  
  RESULTS
  Willingness to join the CHI model for US$30 per year was 69.3%. With affiliation, 92.2% of interviewees stated that they would visit the local health facility more often. Willingness to join was found to be negatively associated with education. Other variables showed no significant association with willingness to join. The study showed a positive attitude toward the CHI scheme. Substantial health care expenditures on the last illness episode were documented.
  
  
  CONCLUSIONS
  The investigation concludes that CHI in the study region is feasible. However, enrollments are likely to be lower than the stated willingness to join. Still, a CHI scheme should present an interesting financing alternative in rural areas where services are scarce and difficult to sustain.
authors.affiliation: Department for Family Medicine, Östergötland County Council, Hälsans Hus, Linköping, Sweden. martin_eckhardt@yahoo.de
authors.forename: Martin
authors.initials: M
authors.lastname: Eckhardt
authors.forename: Birger Carl
authors.initials: BC
authors.lastname: Forsberg
authors.forename: Dorothee
authors.initials: D
authors.lastname: Wolf
authors.forename: Antonio
authors.initials: A
authors.lastname: Crespo-Burgos
mesh_terms: D000328:Adult; D001290:Attitude; D003256:Community Participation; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000191:economics; D004484:Ecuador; D004522:Educational Status; D005240:Feasibility Studies; D005102:Health Expenditures / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D007343:Insurance Carriers / Q000191:economics; D059034:Not-For-Profit Insurance Plans / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D012423:Rural Health; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035502:Trust