INTRODUCTION

Community-based health insurance (CBHI), also known as health insurance for the informal sector or microinsurance, is “a voluntary health insurance scheme organized at the level of the community” (Carrin et al. 2005). The population coverage, services offered, regulation, management, and objectives vary widely. Two main characteristics that distinguish CBHI from national or social health insurance are that the schemes are run by, and for, a specific community, and that enrolment is voluntary. Many CBHI schemes tend to be “not-for-profit prepayment plans for health care with community control and voluntary membership” (Gottret & Schieber 2006) in which a local non-governmental organization (NGO) or a trusted community group administers the enrolment and funds. Jakab and Krishnan (2004) identified three features common to most existing CBHI schemes: (1) affiliation based on community membership and strong community involvement in system management, (2) exclusion of beneficiaries from other kinds of health coverage, and (3) shared social values among members.

Akin to other health insurance, CBHI schemes are based on the fundamental idea that there is uncertainty about a future health outcome, and that this risk can be transferred to another party. Prepayment is made to transfer the risk to the insurer, in exchange for an agreement that the insurer will reimburse the insured for covered losses in the future. The strengths of CBHI include the ability to provide some financial protection and improve access to health care for low-income populations. CBHI can act as a stepping stone to extend health insurance to the informal sector or rural communities (GTZ 2004) and to prevent people from being driven into poverty by catastrophic health expenditures.

High out-of-pocket financing of care and a largely rural and informal sector population in many low- and middle-income countries have made CBHI quite popular in recent years (Ekman 2004). Large informal sectors constrain government capacity to raise taxes where limited government revenue is available to finance health care. Communities have filled in this gap by mobilizing local resources. CBHI schemes have gained international support as part of a solution to health care financing problems, growing from 200 schemes in 2000 (Bennett et al. 2004) to a few thousand worldwide in 2010. While most CBHI schemes operate in sub-Saharan Africa, those in Asia can be located in Bangladesh, China, India, Nepal, Cambodia, Laos, and the Philippines.