@article{fdi:010086773,
  title = {{E}ffects of a free health insurance programme for the poor on health service utilisation and financial protection in {S}enegal},
  author = {{B}ousmah, {M}arwan-al-{Q}ays and {D}iakhate, {P}. and {T}oulao, {G}. {A}. {D}. and {L}e {H}esran, {J}ean-{Y}ves and {L}alou, {R}ichard},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction{I}mplemented in 2013 in {S}enegal, the {P}rogramme {N}ational de {B}ourses de {S}ecurite {F}amiliale ({PNBSF}) is a national cash transfer programme for poor households. {B}esides reducing household poverty and encouraging children's school attendance, an objective of the {PNBSF} is to expand health coverage by guaranteeing free enrolment in community-based health insurance ({CBHI}) schemes. {I}n this paper, we provide the first assessment of the {PNBSF} free health insurance programme on health service utilisation and health-related financial protection.{M}ethods{W}e collected household-level and individual-level cross-sectional data on health insurance in 2019-2020 within the {N}iakhar {P}opulation {O}bservatory in rural {S}enegal. {W}e conducted a series of descriptive analyses to fully describe the application of the {PNBSF} programme in terms of health coverage. {W}e then used multivariate logistic and {P}oisson regression models within an inverse probability weighting framework to estimate the effect of being registered in a {CBHI} through the {PNBSF}-as compared with having no health insurance or having voluntarily enrolled in a {CBHI} scheme-on a series of outcomes.{R}esults{W}ith the exception of health facility deliveries, which were favoured by free health insurance, the {PNBSF} did not reduce the unmet need for healthcare or the health-related financial risk. {I}t did not increase individuals' health service utilisation in case of health problems, did not increase the number of antenatal care visits and did not protect households against the risk of forgoing medical care and of catastrophic health expenditure.{C}onclusion{W}e found limited effects of the {PNBSF} free health insurance on health service utilisation and health-related financial protection, although these failures were not necessarily due to the provision of free health insurance per se. {O}ur results point to both implementation failures and limited programme outcomes. {G}reater commitment from the state is needed, particularly through strategies to reduce barriers to accessing covered healthcare.},
  keywords = {health insurance ; health services research ; health economics ; health policy ; maternal health ; {SENEGAL}},
  booktitle = {},
  journal = {{B}mj {G}lobal {H}ealth},
  volume = {7},
  numero = {{S}uppl. 9},
  pages = {e009977 [10 ]},
  ISSN = {2059-7908},
  year = {2022},
  DOI = {10.1136/bmjgh-2022-009977},
  URL = {https://www.documentation.ird.fr/hor/fdi:010086773},
}