The differences in characteristics between health-care users and non-users: implication for introducing community-based health insurance in Burkina Faso

The purposes of this study are to describe the characteristics of different health-care users, to explain such characteristics using a health demand model and to estimate the price-related probability change for different types of health care in order to provide policy guidance for the introduction of community-based health insurance (CBI) in Burkina Faso. Data were collected from a household survey using a two stage cluster sampling approach. Household interviews were carried out during April and May 2003. In the interviewed 7,939 individuals in 988 households, there were 558 people reported one or more illness episodes; two-thirds of these people did not seek professional care. Health care non-users display lower household income and expenditure, older age and lower perceived severity of disease. The main reason for choosing no-care and self-care was ‘not enough money’. Multinomial logistic regression confirms these observations. Higher household cash-income, higher perceived severity of disease and acute disease significantly increased the probability of using western care. Older age and higher price-cash income ratio significantly increased the probability of no-care or self-care. If CBI were introduced the probability of using western care would increase by 4.33% and the probability of using self-care would reduce by 3.98%. The price-related probability change of using western care for lower income people is higher than for higher income although the quantity changed is relatively small. In conclusion, the introduction of CBI might increase the use of medical services, especially for the poor. Co-payment for the rich might be necessary. Premium adjusted for income or subsidies for the poor can be considered in order to absorb a greater number of poor households into CBI and further improve equity in terms of enrolment. However, the role of CBI in Burkina Faso is rather limited: it might only increase utilisation of western health care by a probability of 4%.