Health Worker Preferences for Community-Based hHalth Insurance Payment Mechanisms: A Discrete Choice Experiment

Two important challenges in establishing and sustaining community-based insurance (CBI) schemes are low rates of community member enrollment and high lapse rates. These factors lead to low CBI coverage which in turn results in low levels of revenue for the risk carrier and limited risk-pooling, which leave CBI schemes financially and organizationally vulnerable to unexpected changes in incomes or high disease incidence. In this paper, an experimental design is used to examine how the relationship between insurance providers and health care facilities - and more specifically payment mechanisms for services delivered by health workers - can influence uptake and renewals. The research discovers that the way health care workers are remunerated by the risk carrier can crucially determine CBI performance and quality of health services as payment mechanisms also influence the way healthcare is delivered. Based on the results from this experiment, a revised CBI payment system based on health workers preferences was introduced in the Nouna district of Burkina Faso in January 2011.