Health insurance and child mortality in rural Burkina Faso.
BACKGROUND
Micro health insurance schemes have been implemented across developing countries as a means of facilitating access to modern medical care, with the ultimate aim of improving health. This effect, however, has not been explored sufficiently.


OBJECTIVE
We investigated the effect of enrolment into community-based health insurance on mortality in children under 5 years of age in a health and demographic surveillance system in Nouna, Burkina Faso.


METHODS
We analysed the effect of health insurance enrolment on child mortality with a Cox regression model. We adjusted for variables that we found to be related to the enrolment in health insurance in a preceding analysis.


RESULTS
Based on the analysis of 33,500 children, the risk of mortality was 46% lower in children enrolled in health insurance as compared to the non-enrolled children (HR=0.54, 95% CI 0.43-0.68) after adjustment for possible confounders. We identified socioeconomic status, father's education, distance to the health facility, year of birth, and insurance status of the mother at time of birth as the major determinants of health insurance enrolment.


CONCLUSIONS
The strong effect of health insurance enrolment on child mortality may be explained by increased utilisation of health services by enrolled children; however, other non-observed factors cannot be excluded. Because malaria is a main cause of death in the study area, early consultation of health services in case of infection could prevent many deaths. Concerning the magnitude of the effect, implementation of health insurance could be a major driving factor of reduction in child mortality in the developing world.
Institute of Public Health, University of Heidelberg, Heidelberg, Germany; schoeps@uni-heidelberg.de.
Anja
A
Schoeps
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Henrike
H
Lietz
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
Ali
A
Sié
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
Germain
G
Savadogo
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Manuela
M
De Allegri
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Olaf
O
Müller
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Rainer
R
Sauerborn
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.|Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Heiko
H
Becher
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Aurélia
A
Souares
D002050:Burkina Faso / Q000453:epidemiology; D046688:Child Mortality; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D012424:Rural Population; D012959:Socioeconomic Factors
Africa South of the Sahara; Burkina Faso; child mortality; health insurance; health services accessibility; population surveillance; survival analysis