Increasingly, low- and middle-income countries are looking to community-based health insurance CBHI) as a means of ensuring access to health care for the poor. However, little evidence exists about the determining factors that affect poor individuals` insurance decisions. This article reviews the economic and social literature on theories of decision-making, and presents empirical findings from different socio-economic contexts to describe individuals` insurance enrolment decisions in a low-income environment. Evidence from these studies suggests that several factors may explain poor households` decision to insure or remain uninsured. Combining empirical evidence with theories may serve to develop health policies to address issues related to the insurance design, the socio-economic and the informational context; with the overall objective of improving access to care for the poor.
Health Policy and Planning (2004) 196):349-55 [doi:10.1093/heapol/czh050]