Summary (English)

Mutual health organizations (MHOs) are voluntary membership organizations providing health insurance services to their members. MHOs aim to increase access to health care by reducing out-of-pocket payments faced by households.  Multiple regression analysis of household survey data were used from Ghana, Mali and Senegal to investigate the determinants of enrolment in MHOs, and the impact of MHO membership on use of health care services and on out-of-pocket health care expenditures for outpatient care and hospitalization.  Strong evidence was found that households headed by women are more likely to enrol in MHOs than households headed by men. Education of the household head is positively associated with MHO enrolment. The evidence on the association between household economic status and MHO enrolment indicates that individuals from the richest quintiles are more likely to be enrolled than anyone else. No evidence was found that individuals from the poorest quintiles were excluded from MHOs.

MHO members are more likely to seek formal health care in Ghana and Mali, although this result was not confirmed in Senegal. While evidence that MHO membership is associated with higher probability of hospitalization is inconclusive, MHO membership offers protection against the potentially catastrophic expenditures related to hospitalization. However, MHO membership does not appear to have a significant effect on out-of-pocket expenditures for curative outpatient care.