Impact of community-based health insurance on health services utilisation among vulnerable households in Amhara region, Ethiopia

Abstract

Background Ethiopia piloted community-based health insurance in 2011, and as of 2019, the programme was operating in 770 districts nationwide, covering approximately 7 million households. Enrolment in participating districts reached 50%, holding promise to achieve the goal of Universal Health Coverage in the country. Despite the government’s efforts to expand community-based health insurance to all districts, evidence is lacking on how enrolment in the programme nudges health seeking behaviour among the most vulnerable rural households. This study aims to examine the effect of community-based health insurance enrolment among the most vulnerable and extremely poor households participating in Ethiopia’s Productive Safety Net Programme on the utilisation of healthcare services in the Amhara region. Methods Data for this study came from Amhara pilot integrated safety net programme baseline survey in Ethiopia and were collected between December 2018 and February 2019 from 5,398 households. We used propensity score matching method to estimate the impacts of enrolment in community-based health insurance on outpatient, maternal, and child preventive and curative healthcare services utilisation. Results Results show that membership in community-based health insurance increases the probabilities of visiting health facilities for curative care in the past month by 8.2 percentage points (95% CI 5.3 to 11.1), seeking care from a health professional by 8.4 percentage points (95% CI 5.5 to 11.3), and visiting a health facility to seek any medical assistance for illness and check-ups in the past 12 months by 13.9 percentage points (95% CI 10.5 to 17.4). Insurance also increases the annual household per capita health facility visits by 0.84 (95% CI 0.64 to 1.04). However, we find no significant effects of community-based health insurance membership on utilisation of maternal and child healthcare services. Conclusions Findings that community-based health insurance increased outpatient services utilisation implies that it could also contribute towards universal health coverage and health equity in rural and informal sectors. The absence of significant effects on maternal and child healthcare services may be due to the free availability of such services for everyone at the public health facilities, regardless of insurance membership. Outpatient services use among insured households is still not universal, and understanding of the barriers to use, including supply-side constraints, will help improve universal health coverage.

Factors associated with undiagnosed hypertension among Tongan adults: a cross-sectional study

“…Currently, in Tonga, health care is free for all citizens [15] and could be the reason why Tongan people do not include health insurance in their budget. In previous studies, having health insurance had positive impacts on health outcomes and the frequency of visits to health care providers [30][31][32][33][34][35]. Thus, it could be a contributing factor for Tongan adults not having regular health check-ups because of a lack of health insurance scheme, but further research and exploration are needed.…”

The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

“…Additionally, there was a multi-country study that encompassed three countries: Ghana, Rwanda, and Indonesia [46]. Most studies (n = 14) were nationally representative of the population, while the remaining three were carried out in specific region(s) within the specified country [42,48,49]. Three studies were specifically conducted in rural settings [42,48,49], and no studies focused on urban settings exclusively.…”

“…Most studies (n = 14) were nationally representative of the population, while the remaining three were carried out in specific region(s) within the specified country [42,48,49]. Three studies were specifically conducted in rural settings [42,48,49], and no studies focused on urban settings exclusively. The rest of the studies (n = 14) covered both rural and urban areas.…”

Tác động của bảo hiểm y tế đến sử dụng dịch vụ y tế của người dân vùng trung du và miền núi phía bắc

“…Các quốc gia thành viên của Liên Hợp Quốc đã cam kết đạt được bao phủ chăm sóc sức khỏe toàn dân (CSSKTD) vào năm 2030 theo các Mục tiêu Phát triển Bền vững (SDGs) (Mussa et al, 2023). Bao phủ CSSKTD hướng đến đảm bảo nhu cầu và khả năng tiếp cận các dịch vụ chăm sóc sức khỏe, thuốc và vắc-xin thiết yếu có chất lượng cho tất cả mọi người và thúc đẩy bảo vệ rủi ro tài chính y tế cho người dân (United Nations, 2016).…”