This week we would like to collect views on the place of community based health insurance (CBHI) mechanisms in national health financing schemes. As scientist we believe ideology shouldn’t take over from science when it comes to defining health financing mechanisms in a country. For us it seems rather obvious that “Beveridge versus Bismarck” is a discussion of the past. Almost all health systems in the world tend to combine components of both systems, the combination then depending on their history and their current context.
As for CBHI schemes, despite their relative failure both in achieving high rates of coverage and protecting the population against serious financial shocks in most settings, they remain an attractive option to many. Some form of CBHI-like systems even gathered significant successes when massively supported by national authorities – obviously, contrary to their very definition- like in Ghana and Rwanda recently.
- What is the place of CBHI schemes in health financing mechanisms for resource poor settings ?
- Do we really need community based insurance? Why? And if yes, what for?
- What kind of indicators shall we use to assess the success or failure of such schemes?
- What are the conditions for these schemes to be sustainable and viable?
- Is subsidization a solution for the sustainability of these schemes ?
- How much state involvement is required to truly scale up CBHI?
- Do the Rwandan and Ghanaian systems correspond to the definition of a CBHI?
As you see, plenty of questions. They are intended as a teaser to encourage you to share your views on the topic. Feel free to comment by email or directly below this blog post.
Amal Shafik and David Hercot