DETERMINANT OF HEALTH INSURANCE ENROLLMENT FOR THE INFORMAL SECTOR IN LOW AND MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW
Keywords:determinant, enrollment, health insurance, informal sector
The health insurance schemes are implemented to achieve universal coverage
through covering medical expenses that emerge due to an illness. This study was a
systematic review to identify and analyze factors associated with health insurance
enrollment for the informal sector that dominates the workforce in most developing
countries. Six databases, namely: PubMed, Taylor and Francis online (Tandfonline),
Science Direct, Scopus, Journal Storage (JSTOR) and Google Scholar were systematically
traced in September-October 2020 to identify English-language research that analyzed the
determinants of health insurance enrollment for the informal sector and published in the
period 2010-2020. A total of 15 articles both quantitative and mix-methods analysis were
included after final assessment. Most of the studies was conducted in Africa and Asia and
only one article was conducted in Latin America. All studies demonstrated several factors
associated to health insurance registration including sociodemographic characteristics,
knowledge, chronic disease, information, and health service utilization, premium, subsidy,
health status, trust, and capital, drug provision, perceived susceptibility, perceive
seriousness, perceived benefit, family and social support. Findings from this systematic
review can be encourage for policy-makers interested in expansion of health insurance
membership for informal workers especially in developing countries.
Aku, K. M., Mensah, K. A., Twum, P., Agyei-Baffour, P., Opoku, D., & Brenyah, J. K. (2021). Factors Influencing Nonrenewal of Health Insurance Membership in Ejisu-Juaben Municipality of Ashanti Region, Ghana. Advances in Public Health, 2021(2010). https://doi.org/10.1155/2021/5575822
Amin, A. T. M., & Singh, A., & Amin, A. T. M. N. (2002). The informal sector in Asia from the decent work perspective. International Labour Organization., 121. www.ilo.org/publns
Azuogu, B., Madubueze, U., Alo, C., Ogbonnaya, L., & Ajayi, N. (2016). Level of awareness, and factors associated with willingness to participate in the National Health Insurance Scheme among traders in Abakaliki main market, Ebonyi State, Nigeria. African Journal of Medical and Health Sciences, 15(1), 18. https://doi.org/10.4103/2384-5589.183887
Badu, E., Agyei-Baffour, P., Ofori Acheampong, I., Preprah Opoku, M., & Addai-Donkor, K. (2018). Households Sociodemographic Profile as Predictors of Health Insurance Uptake and Service Utilization: A Cross-Sectional Study in a Municipality of Ghana. Advances in Public Health, 2018, 1–13. https://doi.org/10.1155/2018/7814206
Boateng, S., Amoako, P., Poku, A. A., Baabereyir, A., & Gyasi, R. M. (2017). Migrant female head porters’ enrolment in and utilisation and renewal of the National Health Insurance Scheme in Kumasi, Ghana. Journal of Public Health, 25(6), 625–634.
Chankova, S., Sulzbach, S., & Diop, F. (2008). Impact of mutual health organizations: Evidence from West Africa. Health Policy and Planning, 23(4), 264–276. https://doi.org/10.1093/heapol/czn011
Dartanto, T., Halimatussadiah, A., Rezki, J. F., Nurhasana, R., Siregar, C. H., Bintara, H., Usman, Pramono, W., Sholihah, N. K., Yuan, E. Z. W., & Soeharno, R. (2020). Why Do Informal Sector Workers Not Pay the Premium Regularly? Evidence from the National Health Insurance System in Indonesia. Applied Health Economics and Health Policy, 18(1), 81–96. https://doi.org/10.1007/s40258-019-00518-y
Dartanto, T., Rezki, J. F., Pramono, W., Siregar, C. H., Bintara, U., & Bintara, H. (2016). Participation of informal sector workers in Indonesia’s national health insurance system. Journal of Southeast Asian Economies, 317–342.
Dong, H., Kouyate, B., Snow, R., Mugisha, F., & Sauerborn, R. (2003). Gender’s effect on willingness-to-pay for community-based insurance in Burkina Faso. Health Policy, 64(2), 153–162. https://doi.org/10.1016/S0168-8510(02)00144-6
Eseta, W. A., Lemma, T. D., & Geta, E. T. (2020). Magnitude and determinants of dropout from community-based health insurance among households in Manna District, Jimma Zone, Southwest Ethiopia. ClinicoEconomics and Outcomes Research, 12, 747–760. https://doi.org/10.2147/CEOR.S284702
Fadlallah, R., El-Jardali, F., Hemadi, N., Morsi, R. Z., Abou Samra, C. A., Ahmad, A., Arif, K., Hishi, L., Honein-Abouhaidar, G., & Akl, E. A. (2018). Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: A systematic review. International Journal for Equity in Health, 17(1), 1–18. https://doi.org/10.1186/s12939-018-0721-4
Greef, T. D. G. De, Monareng, L. V., & Roos, J. H. (2016). A quantitative study on factors influencing enrolment of dairy farmers in a community health insurance scheme. BMC Health Services Research, 16(1), 1–10. https://doi.org/10.1186/s12913-016-1925-1
Hendryx, M., Onizuka, R., Wilson, V., & Ahern, M. (2012). Effects of a cost-sharing policy on disenrollment from a state health insurance program. Social Work in Public Health, 27(7), 671–686. https://doi.org/10.1080/19371910903269653
Jehu-Appiah, C., Aryeetey, G., Agyepong, I., Spaan, E., & Baltussen, R. (2012). Household perceptions and their implications for enrolment in the National Health Insurance Scheme in Ghana. Health Policy and Planning, 27(3), 222–233. https://doi.org/10.1093/heapol/czr032
Kebede, A. (2014). Willingness to Pay for Community Based Health Insurance among Households in the Rural Community of Fogera District, North West Ethiopia. International Journal of Economics, Finance and Management Sciences, 2(4), 263. https://doi.org/10.11648/j.ijefm.20140204.15
Kidd, S., & Damerau, V. (2016). The Political Economy of Social Protection for Informal Economy Workers in Asia. In Social Protection for Informal Workers in Asia. www.adb.org
Macha, J., Kuwawenaruwa, A., Makawia, S., Mtei, G., & Borghi, J. (2014). Determinants of community health fund membership in Tanzania: a mixed methods analysis. BMC Health Services Research, 14, 538. https://doi.org/10.1186/s12913-014-0538-9
Masanyiwa, Z. S., Mosha, E. S., & Mamboya, S. F. (2020). Factors Influencing Participation of Informal Sector Workers in Formal Social Security Schemes in Dodoma City, Tanzania. Open Journal of Social Sciences, 8(06), 229.
Mathiyazhagan, K. (1998). Willingness to pay for rural health insurance through community participation in India. International Journal of Health Planning and Management, 13(1), 47–67. https://doi.org/10.1002/(SICI)1099-1751(199801/03)13:1<47::AID-HPM495>3.0.CO;2-I
Mirach, T. H., Demissie, G. D., & Biks, G. A. (2019). Determinants of community-based health insurance implementation in west Gojjam zone, Northwest Ethiopia: A community based cross sectional study design. BMC Health Services Research, 19(1), 1–8. https://doi.org/10.1186/s12913-019-4363-z
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., Altman, D., Antes, G., Atkins, D., Barbour, V., Barrowman, N., Berlin, J. A., Clark, J., Clarke, M., Cook, D., D’Amico, R., Deeks, J. J., Devereaux, P. J., Dickersin, K., Egger, M., Ernst, E., … Tugwell, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7). https://doi.org/10.1371/journal.pmed.1000097
Nageso, D., Tefera, K., & Gutema, K. (2020). Enrollment in community based health insurance program and the associated factors among households in Boricha district, Sidama Zone, Southern Ethiopia; a cross-sectional study. PLoS ONE, 15(6), 1–14. https://doi.org/10.1371/journal.pone.0234028
Nga, N. T. T., Xiem, C. H., & Anh, B. T. M. (2020). Universal coverage challenges: Determinants of enrolment in family-based social health insurance. International Journal of Healthcare Management, 1–7.
Noubiap, J. J. N., Joko, W. Y. A., Obama, J. M. N., & Bigna, J. J. R. (2013). Community-based health insurance knowledge, concern, preferences, and financial planning for health care among informal sector workers in a health district of Douala, Cameroon. Pan African Medical Journal, 16, 1–9. https://doi.org/10.11604/pamj.2013.16.17.2279
Nsiah-Boateng, E., Nonvignon, J., Aryeetey, G. C., Salari, P., Tediosi, F., Akweongo, P., & Aikins, M. (2019). Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: A cross-sectional study. Health Economics Review, 9(1). https://doi.org/10.1186/s13561-019-0241-y
Nugraha, A., Ulfah, N., Isa, M., & Ilmi, B. (2019). Factors Influencing the Participation of National Health Insurance Independently. Indian Journal of Public Health Research & Development, 10(4), 561–566.
Ogben, C., & Ilesanmi, O. S. (2018). Community based health insurance scheme: Preferences of rural dwellers of the federal capital territory Abuja, Nigeria. Journal of Public Health in Africa, 9(1), 54–59. https://doi.org/10.4081/jphia.2018.540
Prakoso, A. D., Sulaeman, E. S., & Suryono, A. (2020). Application of Health Belief Model on Factors Affecting Participation in the National Health Insurance Scheme among Informal Sector Workers in Kudus, Central Java. Journal of Health Policy and Management, 5(1), 61–73.
Pythagore H, Donfouet P, Mahieu EMP, M. E. (2015). Fdre- Evaluation of Community-Based Health Insurance Pilot Schemes in Ethiopia: Final Report. May, 21.
Ranabhat, C. L., Subedi, R., & Karn, S. (2020). Status and determinants of enrollment and dropout of health insurance in Nepal: An explorative study. Cost Effectiveness and Resource Allocation, 18(1), 1–13. https://doi.org/10.1186/s12962-020-00227-7
Rothenberg, A. D., Gaduh, A., Burger, N. E., Chazali, C., Tjandraningsih, I., Radikun, R., Sutera, C., & Weilant, S. (2016). Rethinking Indonesia’s Informal Sector. World Development, 80, 96–113. https://doi.org/10.1016/j.worlddev.2015.11.005
Salari, P., Akweongo, P., Aikins, M., & Tediosi, F. (2019). Determinants of health insurance enrolment in Ghana: Evidence from three national household surveys. Health Policy and Planning, 34(8), 582–594. https://doi.org/10.1093/heapol/czz079
Sari, B., & Idris, H. (2019). Determinant of independent national health insurance ownership in Indonesia. Malaysian Journal of Public Health Medicine, 19(2), 109–115.
Sarker, A. R., Sultana, M., Mahumud, R. A., Ahmed, S., Islam, Z., Morton, A., & Khan, J. A. M. (2017). Determinants of enrollment of informal sector workers in cooperative based health scheme in Bangladesh. PloS One, 12(7), e0181706. https://doi.org/10.1371/journal.pone.0181706
Savitha, B. (2017). Why Members Dropout? An Evaluation of Factors Affecting Renewal in Micro Health Insurance. Journal of Health Management, 19(2), 292–303. https://doi.org/10.1177/0972063417699691
Selcuk, A. A. (2019). A Guide for Systematic Reviews: PRISMA. Turkish Archives of Otorhinolaryngology, 57(1), 57–58. https://doi.org/10.5152/tao.2019.4058
Taddesse, G., Atnafu, D. D., Ketemaw, A., & Alemu, Y. (2020). Determinants of enrollment decision in the community-based health insurance, North West Ethiopia: a case-control study. Globalization and Health, 16(1), 4. https://doi.org/10.1186/s12992-019-0535-1
Thornton, R. L., Hatt, L. E., Field, E. M., Islam, M., Solís Diaz, F., & González, M. A. (2010). Social security health insurance for the informal sector in Nicaragua: a randomized evaluation. Health Economics, 19(S1), 181–206.
Wagstaff, A. (2000). Research on Equity, Poverty and Health Outcomes. In October (Issue October).
Wagstaff, A., Nguyen, H. T. H., Dao, H., & Bales, S. (2016). Encouraging health insurance for the informal sector: A cluster randomized experiment in Vietnam. Health Economics (United Kingdom), 25(6), 663–674. https://doi.org/10.1002/hec.3293
How to Cite
Copyright (c) 2023 Asmaripa Ainy, Pujiyanto
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Conference Proceedings of International Conference on Public Health is entirely Open Access, which means that all published content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this Proceedings journal without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
Authors who publish with Conference Proceedings agree to the following terms:
- Authors retain copyright and grant the Proceedings of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this conference proceedings.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the proceeding's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this conference proceedings.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Published articles are licensed under a Creative Commons Attribution 4.0 International License.