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. 2023 Jan 23;23(1):67.
doi: 10.1186/s12913-022-09019-6.

The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia

Yibeltal Kiflie Alemayehu #  1 , Ermias Dessie #  2 , Girmay Medhin  3 , Negalign Birhanu  4 , David R Hotchkiss  5 , Alula M Teklu  3 , Mizan Kiros  6
Affiliations

The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia

Yibeltal Kiflie Alemayehu et al. BMC Health Serv Res. .

Abstract

Background: Evidence on the effectiveness of community-based health insurance (CBHI) in low-income countries is inconclusive. This study assessed the impact of CBHI on health service utilization and financial risk protection in Ethiopia.

Methods: We conducted a comparative cross-sectional study nested within a larger national household survey in 2020. Data was collected from three groups of households-CBHI member households (n = 1586), non-member households from CBHI implementing woredas (n = 1863), and non-member households from non-CBHI implementing woredas (n = 789). Indicators of health service utilization, out-of-pocket health spending, catastrophic health expenditure, and impoverishment due to health spending among CBHI members were compared with non-members from CBHI implementing woredas and households from non-CBHI implementing woredas. Propensity score matching (PSM) was used to account for possible selection bias.

Results: The annual number of OPD visits per capita among CBHI member households was 2.09, compared to 1.53 among non-member households from CBHI woredas and 1.75 among households from non-CBHI woredas. PSM estimates indicated that CBHI members had 0.36 (95% CI: 0.25, 0.44) and 0.17 (95% CI: -0.04, 0.19) more outpatient department (OPD) visits per capita per year than their matched non-member households from CBHI-implementing and non-CBHI implementing woredas, respectively. CBHI membership resulted in a 28-43% reduction in annual OOP payments as compared to non-member households. CBHI member households were significantly less likely to incur catastrophic health expenditures (measured as annual OOP payments of more than 10% of the household's total expenditure) compared to non-members (p < 0.01).

Conclusion: CBHI membership increases health service utilization and financial protection. CBHI proves to be an important strategy for promoting universal health coverage. Implementing CBHI in all woredas and increasing membership among households in woredas that are already implementing CBHI will further expand its benefits.

Keywords: Community-based health insurance; Ethiopia; Financial risk protection; Health care utilization; Health financing.

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Conflict of interest statement

MERQ is an independent research institution with no conflicts of interest in relation to this study. All authors declared that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Financial and non-financial reasons for not seeking care during illness
See this image and copyright information in PMC

References

    1. United Nations. Sustainable Development Goals: 17 goals to transform our world2015. Available from: https://www.un.org/sustainabledevelopment/sustainable-development-goals/.
    1. World Health Organization. World health statistics 2020: Monitoring health for the SDGs, sustainable development goals2020. Available from: https://apps.who.int/iris/bitstream/handle/10665/332070/9789240005105-en....
    1. World Health Organization . Global Health Expenditure Database. 2021.
    1. Ifeagwu SC, Yang JC, Parkes-Ratanshi R, Brayne C. Health financing for universal health coverage in Sub-Saharan Africa: a systematic review. Glob Health Res Policy. 2021;6(1):8. doi: 10.1186/s41256-021-00190-7. - DOI - PMC - PubMed
    1. Etienne C, Evans DB. The world health report [2010] : health systems financing : the path to universal coverage. 2010. - PMC - PubMed

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