Community-based health insurance (CBHI) schemes are promoted in sub-Saharan Africa to improve healthcare access and financial protection. While a prior study in Mali linked CBHI enrolment to increased general healthcare use, its specific effect on surgical service utilisation, a critical health system component, is not well established and requires verification. This replication study assessed the impact of a CBHI scheme on surgical service utilisation in the Kayes region of Mali. Its primary objective was to determine whether enrolment led to a measurable change in the rate of surgical procedures accessed. A quasi-experimental design was employed, analysing longitudinal administrative data from the Kayes CBHI scheme and linked surgical records from participating health facilities. The study cohort comprised insured households and a matched comparison group of uninsured households. The primary outcome was the incidence of surgical utilisation per 1,000 person-years. Statistical analyses included difference-in-differences estimation to control for underlying trends. Enrolment in the CBHI scheme was associated with a statistically significant increase in surgical utilisation. The incidence rate among the insured population was approximately 40% higher than in the matched uninsured comparison group. This increase was observed for both elective and emergency surgical procedures. The replication confirms that the CBHI scheme in Kayes had a substantial positive effect on access to surgical care. This supports the role of such financial mechanisms in strengthening health system coverage for essential surgical services. Policymakers should consider integrating and sustainably financing CBHI schemes within national health strategies, with explicit inclusion of surgical care packages. Further research should investigate the cost-effectiveness and long-term financial sustainability of these schemes for surgical care. community-based health insurance, surgical access, utilisation, Mali, replication study, health financing. This study provides replicated evidence on the impact of a community-based health insurance scheme on surgical utilisation, contributing robust findings to inform health financing policy for surgical systems in similar contexts.
Diakité et al. (Tue,) studied this question.