Making Sense of a Fragmented Health System the Health-Seeking Journey of Poor Urban Haitian Women With a Short- Term Insurance in Port-Au-Prince, Haiti a Mixed-Methods Study

Abstract

Despite the great progress in health technologies and treatment, health coverage remains a major challenge in the world, especially in developing countries. Important disparities in health care access persist between rich and poor countries and within countries between the first and the 5th quintiles. In Haiti, only 47% of the population has access to health care with only 25% of institutional delivery for the poorest population comparing to 78,2% for the richest [1] “Reliance on direct payment constitutes one of the main obstacles that prevent people from seeking for Health Care “[2]. This leads to complications related to late consultations, high mortality and morbidity rate, high rate of preventable diseases and deaths, etc. Direct payment also cause financial hardship, especially for poorer populations [3] which aggravate their socio-economical condition and create room for future health issues. In view of this situation, most countries, rich and poor alike, are contemplating health insurance as a solution to improve the access to health care and also reduce the financial burden of health expenditure for poor people. In the past decade, a lot of developing countries, such as Rwanda, Vietnam, achieved important improvement in health care access for their population with their health insurance scheme. In Haiti it is already part of a national conversation, and although most of the health insurance plans are private, there are some efforts to extend this option for the poor, such as the International Organization for Migration (IOM) health insurance for the vulnerable camp population in Port-au-Prince. Nonetheless, before considering to scale up to the national system, we need to evaluate if health insurance can really improve the access to health care for the poor populations in Haiti? To address this question we propose to conduct a retrospective cohort study to assess the impact of IOM health insurance plan on the access to health care for the camp population, in Port-au-Prince, Haiti. The main objective of this study is to evaluate whether IOM health insurance plan has improved the access to health care for 300 pregnant women in fifty(50) internal displaced camps in Port-au-Prince, Haiti. The Specific Aims are: 1) Study how health insurance plans affect the frequency of medical consultation 2) Estimate the impact of health insurance on health expenditure