This paper provides empirical evidenceregarding the performance of community-based health carefinancing in terms of (a) social inclusion and (b) financialprotection. Five non-standardized household surveys wereanalyzed from India (two samples), Senegal, Rwanda, andThailand. Common methodology was applied to the five datasets. Logistic regression was used to estimate thedeterminants of enrolling in a community financing scheme. Atwo-part model was used to assess the determinants offinancial protection: part one used logistic regression toestimate the determinants of the likelihood of visiting ahealth care provider; part two used ordinary least-squaresregression to estimate the determinants of out-of-pocketpayments. The research finds: (a) Social inclusion. Thefindings suggest that community financing can be inclusiveof the poorest even in the most economically deprivedcontext. Nevertheless, this targeting outcome is notautomatically attributable to the involvement of thecommunity; rather it depends on key design andimplementation characteristics of the schemes. (b) Financialprotection. Community financing reduces financial barriersto health care as demonstrated by higher utilization andsimultaneously lower out-of-pocket expenditure of schememembers controlling for a range of socioeconomic variables.The paper concludes: (a) Social inclusion. Design andimplementation characteristics of community financingschemes matter to achieve good targeting outcome-communityinvolvement alone does not guarantee social inclusion.Further research is needed to delineate which design andimplementation characteristics allow better inclusion of thepoor. (b) Financial protection. Prepayment and risk sharing,even on a small scale, reduce financial access barriers.
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