The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study

Abstract

IntroductionMoving towards the goal of universal health coverage requires strengthening service delivery and overcoming significant financial barriers. The Government of Ethiopia is rolling out community based health insurance to protect the rural community from high out of pocket health expenditure and improve health service utilization. We investigated the effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia.MethodsA community based cross sectional study was conducted. A Multi stage sampling technique was used to get a total of 454 (224 insured and 230 uninsured) households. The data were entered using EPI info version 7 and analyzed using SPSS version 20 and STATA version 13 for binary logistic regression analysis and propensity score matching analysis respectively. Wealth status of the households was computed by Principal Component Analysis (PCA). A multivariable logistic regression analysis was done to identify the predictors of catastrophic health expenditure. Propensity score matching analysis was used to determine the effect of community based health insurance on catastrophic health expenditure. The average treatment effect on the treated (ATT) was calculated to compare the means of outcomes across insured and uninsured households.ResultsA total of 454 household heads were included in the study, making a response rate of 91.2%.The total level of catastrophic health expenditure was found to be 20%. Among the households with catastrophic health expenditure, 4.41% were insured, whereas the remaining 15.64% were noninsured. Insured households (AOR = 0.19, 95% CI: 0.11–0.34), rich households (AOR = 1.98; 95% CI: 1.07–3.66), having member with chronic illness (AOR = 2.13, 95% CI: 1.01–4.51) and having member encountered any illness during the past 3 months (AOR = 2.44, 95% CI: 1.35–4.40) were statistically associated with catastrophic health expenditure. Community based health insurance contributed to 23.2% (t = -5.94) (95% CI: -0.31_-0.15) reduction of catastrophic health expenditure.ConclusionThe overall level of catastrophic health expenditure was high among noninsured households. Community based health insurance has significant financial protection from catastrophic health expenditure in northeast Ethiopia. Thus, the government need to scale up community based health insurance to protect the noninsured households from catastrophic health expenditure.

Factors associated with the perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian demographic and health survey

“…Similarly, women had no health insurance coverage associated with increased odds of health care access problems. This finding was consistent with previous studies [31]. Community-based health insurance has been implemented in Ethiopia since 2010 that protects the individual from unexpected catastrophic expenditure and minimize difficulties in obtaining money for consultation of the doctor [31].…”

Factors associated with the perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian Demographic and Health Survey

“…Similarly, women had no health insurance coverage associated with increased odds of health care access problems. This nding was consistent with previous studies [31]. Community-based health insurance is implemented in Ethiopia since 2010 that protects the individual from unexpected catastrophic expenditure and minimize di culties to obtain money for consultation of the doctor [31].…”

“…This nding was consistent with previous studies [31]. Community-based health insurance is implemented in Ethiopia since 2010 that protects the individual from unexpected catastrophic expenditure and minimize di culties to obtain money for consultation of the doctor [31]. Likewise, lower educational status below is associated with increased perceived barriers of health care access among women of reproductive age.…”

Factors affecting community based health insurance utilization in Ethiopia: A systematic review

“…However, the catastrophic out of pocket (OOP) expenditure [8,9] continues to be the main alternative of financing health care in Ethiopia [9]. Thus, Ethiopian government has been devoted to find a way to shift from catastrophic OOP expenditure [10,11] to ensure accessibility [11,12] targeting on quality and equity [5,6] to achieve UHC [12,13]. As a result, health insurance has been taken as a strategy in 2008 [6] with two schemes (risk-pooling arrangements) called social health insurance for the formal sector and community-based health insurance (CBHI) for the informal sector [4,13,14] to cover all citizens with the exception of defense forces [13].…”