Abstract:

In 2018, Zambia implemented the Social Health Insurance act as a way of sustainable health care financing and reducing out of pocket expenditures. However, the Social Health Insurance has focused mainly on those in formal employment and has not outlined a clear approach towards the informal sector. A total of 213 research participants were selected in Lusaka district. The study design was a quantitative cross-sectional study and subjects were selected by multistage sampling. The respondents were selected from each of the 5 primary health facility catchment areas from Lusaka district. Multivariate analysis using logistic regression was used to identify financial flow factors associated with sustainable prepayment. The study found that the majority of the respondent were in the non-food business and had run the business for more than 5years. The study found that half of the respondent felt that insurance was beneficial and that contributions should be contributed as an indirect levy. Results of the multivariate analysis found that monthly income greater than K1000 (OR, 0.1, p<0.05) and expenditure on health-related needs above K1000 (OR, 44.1, P<0.05) was associated with sustainable prepayment. The study concluded that monthly income and expenditure on health needs were sustainable predictors of health sector prepayment among the urban informal sector. There is need for the stakeholders to make efforts to design and implement health insurance schemes that will incorporate the different strata of the socio-economic groups. There is need to ensure that insurance contributions are collected as an indirect levy rather than as a direct premium.

Keywords: health insurance, financial flow, prepayment, sustainable, informal sector, policy.

References:

[1].   Barkan, Steven E.2011, "Sociology, Understanding and Changing the Social World" (2011). Faculty and Staff Monograph Publications. 2. https://digitalcommons.library.umaine.edu/fac_monographs/2.

[2].   Laokri S, Weil O, Drabo KM, Dembelé SM, Kafando B, Dujardin B. 2013, Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso. Bulletin of the World Health Organization. 2013; 91:277–82. 10.2471/BLT.12.110015.

[3].   Leive A, Xu K.2008, Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bulletin of the World Health Organization. 2008; 86:849–56C. 10.2471/BLT.07.049403.

[4].   Nabyonga Orem J, Mugisha F, Kirunga C, Macq J, Criel B.2011, Abolition of user fees: the Uganda paradox. Health policy and planning. 2011;26(suppl_2): ii41–ii51. 10.1093/heapol/czr065.

[5].   Nimpagaritse M, Bertone MP (2011). The sudden removal of user fees: the perspective of a frontline manager in Burundi. Health Policy Plan. 2011;26(Suppl 2):63–71.

[6].   Okungu, V., Chuma, J., Mulupi, S., & McIntyre, D.,2018, Extending coverage to informal sector populations in Kenya: design preferences and implications for financing policy, BMC Health Services Research, 2018, Volume 18, Number 1.

[7].   Ricardo, B.,2014, Universal Health Coverage and the challenges of the informal sector: lessons from developing countries, World Bank, Washington, DC 201433.

[8].   Robert E, & Ride V.2013. Global health actors no longer in favor of user fees: a documentary study. Global Health. 2013 Jul 26; 9:29. doi: 10.1186/1744-8603-9-29. PubMed PMID: 23889807; PubMed Central PMCID: PMC3750575.

[9].   Qin VM, Hone T, & Millett C.,2019The impact of user charges on health outcomes in low-income and middle-income countries: a systematic review, BMJ Global Health 2019;3: e001087.

[10].  World bank, 2014, Annual meetings of the Boards of governors, Washington DC, October 2011 to 2014.

[11].  Xiao, W.,2018, Effects of marital status on household commercial health insurance participation behavior, Journal of Interdisciplinary Mathematics, Vol 21:2 Taylor & Francis, doi:10.1080/09720502.2017.1420569,

https://doi.org/10.1080/09720502.2017.1420569.