Mot clés: Mutuelles de santé,
accessibilité aux services de santé, Byumba
SUMMARY
This study has the aim of determining the role of adherence to
the community based health insurance in the accessibility of the population to
the health services in the Health district of Byumba.
This analytical cross sectional study was undertaken in august
2005 in 600 households and in the three community based health insurances and
three health centers which are the dispensary of Byumba, the health centers of
Mulindi and Rushaki. The household survey has used a questionnaire in order to
determine the sociodemographic characteristics of the members of prepayment
scheme and non-members, a form was used to collect the data concerning the use
of the health services, adherence at the prepayment scheme, the cost of health
services and the financing of the health centers and the mutual health
organisations.
The univariate analysis by the proportions comparison and the the
multivariate analysis using the logistic model were mainly used. The value of
significativity is P<0,05.
The Odds ratio different from 1 for the confidence interval of
95% was applied to seek a possible association related to the use of the
services by the members or non-members.
The results show that membership to the community health
insurance in the three health centers was 57%; weak membership was observed
at the households whose chiefs were female, the widows, the unemployed one,
having big size, and having a low income.
The total rate of use of the curative primary consultation was
0,70 NC/hab./year and respectively was 0,92. NC/hab/year among members, and
0,42 NC/hab/year among non-members; the level of use of maternity is 0,50 among
women members, whereas it is only 14% among non-members; the use of the
reference is 0,2 among members, versus 0,5 among non-members; this paradoxal
situation is due to use of this service essentially by the population, non
members living in area of Byumba dispensary. It was observed that 80% of the
members of the prepayment scheme always make recourse to the health services
earlier when they are sick, and that 78% realize it during the first 24 hours
of the disease, whereas among non-members these frequencies are respectively
11% and 14%. 95% of members use the usual source of health care, whereas
approximately 5% are made look after elsewhere, these frequencies are
respectively 68% and 32% among non-members; 97% of the members had paid the
totality of the invoice versus 58% of non-members.
The financial constraints are quoted by 75,4% of the non-members
like reason for non adherence to the mutual health insurance. These
organizations generate approximately 70% of the total revenues coming from the
care and 77% of the receipts coming from the drugs. The principal source of
financing of the health centers is the population which contributes at 70%.
The principal source of financing of the mutual health
organizations is the contributions of the population which is estimated at 61%
and the popular tribunal GACACA which finance approximately 26%.
This study enabled us to conclude that adherence to mutual health
organizations is the most important determinant of the accessibility of the
population to the health services, that the care is more expensive among
members than among non-members, and that the population became the principal
current backer of the health centers and the community based health insurances.
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