Abstract
Across West Africa, countries are promoting new models of community-based health insurance (CBHI) to overcome the challenges faced by existing schemes. We investigated factors associated with an individual's probability to be enrolled in one of two professionally-managed CBHI in Mali. We carried out a case-control methodology and used multi-stage sampling to select CBHI members and non-members. The primary outcome variable was being enrolled or not in the CBHI. Three-level mixed-effects logistic regression model was used to estimate the association between individual enrolment and series of individual, household, and wider community factors. Of the 1,270 people surveyed 847 and 423 were non-members and members respectively. Respondents with primary education (AOR = 1.6, P = 0,035), secondary education (AOR = 2.31, P = 0,001) or higher school/University (AOR = 5.5, P < 0,001); who were economically active (AOR = 1.52, P = 0,05) and considered themselves wealthy (AOR = 1.94, P < 0,001) were more likely to subscribe to CBHI. Those who reported having a good perception of their health (AOR = 0.68, P = 0,038) were less likely to subscribe to CBHI. Albeit substantially higher than what experienced by community-based schemes, membership in these professionally-managed CBHI remains low and the determinants of participation do not differ substantially from what reported in the general literature. Targeting the needs of poor vulnerable people and more pervasive communication strategies are urgently needed to enhance enrolment in these new CBHI and ensure the way to UHC.