Herberholz Chantal, Fakihammed Wael Ahmed
Faculty of Economics, Centre for Health Economics, Chulalongkorn University, Bangkok, 10330, Thailand.
National Health Insurance Fund (NHIF), Kassala, Sudan.
Appl Health Econ Health Policy. 2017 Apr;15(2):215-226. doi: 10.1007/s40258-016-0281-y.
Low enrolment and high drop-out rates are common problems in voluntary health insurance schemes. Yet, most studies in this research area focus on community-based health insurance and enrolment, rather than drop-out.
This study examines what causes informal sector families not to renew their voluntary National Health Insurance Fund (NHIF) health insurance membership in Eastern Sudan.
Primary data from about 600 informal sector households that dropped out or remained insured, collected through a household survey conducted in March 2014, were used. Logistic regressions were employed to examine what determines drop-out of the voluntary NHIF scheme.
The logistic regression results are consistent with the existing literature and confirm the importance of household head, household and community characteristics. Notably, worse family health status and higher health care utilization decrease the probability of drop-out, which requires further analysis as it may indicate the problem of adverse selection and insufficient risk management. Most importantly, the results consistently show that household heads who are satisfied with health services and those who understand the main features of the voluntary NHIF scheme are less likely to drop out. Also, 30 % of drop-out households hold a social support card and reported that the social support scheme is the main reason for not renewing their voluntary NHIF health insurance membership as they qualify for sponsored NHIF health insurance membership.
This study shows that satisfaction with health services and knowledge of the health insurance scheme are important factors explaining drop-out of a national health insurance programme. The results suggest that education and information campaigns should be developed further to raise understanding of the NHIF voluntary scheme. In addition, information systems and coordination between the main agencies should be strengthened to reduce administrative costs and ensure policy coherence.
低参保率和高退保率是自愿医疗保险计划中的常见问题。然而，该研究领域的大多数研究都集中在基于社区的医疗保险和参保方面，而非退保问题。
本研究探讨了导致苏丹东部非正规部门家庭不续保其自愿性国家医疗保险基金（NHIF）医疗保险的原因。
使用了2014年3月通过家庭调查收集的约600户非正规部门家庭的原始数据，这些家庭要么已退保，要么仍保有保险。采用逻辑回归分析来研究决定自愿性NHIF计划退保的因素。
逻辑回归结果与现有文献一致，证实了户主、家庭及社区特征的重要性。值得注意的是，家庭健康状况较差和医疗保健利用率较高会降低退保概率，这需要进一步分析，因为这可能表明存在逆向选择和风险管理不足的问题。最重要的是，结果始终表明，对医疗服务满意且了解自愿性NHIF计划主要特征的户主退保可能性较小。此外，30%的退保家庭持有社会支持卡，并表示社会支持计划是他们不续保自愿性NHIF医疗保险的主要原因，因为他们符合获得赞助的NHIF医疗保险资格。
本研究表明，对医疗服务的满意度和对医疗保险计划的了解是解释国家医疗保险计划退保情况的重要因素。结果表明，应进一步开展教育和宣传活动，以提高对NHIF自愿计划的认识。此外，应加强主要机构之间的信息系统和协调，以降低行政成本并确保政策连贯性。
