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

Alemayehu, Yibeltal Kiflie; Dessie, Ermias; Medhin, Girmay; Birhanu, Negalign; Hotchkiss, David R.; Teklu, Alula M.; Kiros, Mizan

doi:10.1186/s12913-022-09019-6

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…Among the higher quality studies, that is, those with low overall risk of bias from RoB 2.0 and ROBINS-I assessments: 10 out of 13 studies, 20 out of 25 studies, and 10 out of 20 studies reported a positive relationship between CBHI enrolment and healthcare utilization, use of outpatient health services, and inpatient hospitalization, respectively. Two high-quality studies, however, reported CBHI enrolment decreased inpatient hospitalization [ 41 , 77 ]. The existing evidence suggests that the government-supported community-involved model had the greatest impact on healthcare utilization– Table 3 .…”

Section: Resultsmentioning

confidence: 99%

“…The existing evidence suggests that the government-supported community-involved model had the greatest impact on healthcare utilization– Table 3 . However, the two studies showing a negative impact of CBHI on healthcare utilization were also a government-supported community-involved model in SSA, suggesting that government support in this region could have both favourable and unfavourable effects [ 41 , 77 ]. In addition, the impact of CBHI on healthcare utilization generally improves as the scheme with older schemes– Table 3 .…”

Section: Resultsmentioning

confidence: 99%

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Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis

2023

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Background To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). Methods We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane’s Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796. Results We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04–2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22–2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61–3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74–3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92–0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54–0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54–0.96). The main limitations of our study are the limited data available for meta-analyses and high heterogeneity persisted in subgroup and sensitivity analyses. Conclusions Our study shows that CBHI generally improves healthcare utilization but inconsistently delivers financial protection from health expenditure shocks. With pragmatic context-specific policies and operational modifications, CBHI could be a promising mechanism for achieving universal health coverage (UHC) in LMICs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis

2023

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“…The program involved the expansion of healthcare facilities, training of healthcare workers, and the introduction of health insurance schemes to ensure financial access to healthcare services. According to a study by Karema et al (2012), the program has had a significant impact on the health outcomes of Rwandans, particularly in reducing infant mortality rates and improving access to healthcare for vulnerable populations. The study also found that the program has been successful in reducing out-ofpocket healthcare costs for households, which has helped to alleviate poverty in the country.…”

Section: Health Sector Reformmentioning

confidence: 99%

Historical Development of Governance in Rwanda and How the Development Shaped the Landscape of Its Institutions

CELESTIN, PhD, PGDE

2023

strategicjournals.com

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Rwanda is a country with a turbulent recent history punctuated by recurrent identity-based violence with harrowing and notorious effects. Political turmoil in Rwanda has been a cyclic and had reached its peak with the 1994 Genocide against the Tutsi where hundreds of thousands of Tutsis were systematically killed under the leadership of Hutu extremists then in power after the obscure shooting down of the aircraft of Hutu President Habyarimana Juvenal. Twenty nine years have now passed since the genocide against the Tutsi and the military victory of the RPF that liberated the country and stopped the Genocide against the Tutsi. During this period, a new generation has been born and raised under the leadership of the RPF. This generation, which has no direct recollection of the genocide against the Tutsi and of the events and circumstances that led to it, is being brought up with the expectation of moving towards a better future based on the harsh lessons of the past. Post-conflict states face more difficulties than others to develop. This is not surprising considering the many challenges associated with ensuring peace and stability, reconstructing the state, rebuilding infrastructure, etc. Africa indeed has a number of examples of post-conflict states that struggle with improving their desperate conditions. The new aid paradigm, that focuses on country ownership of development and the strengthening of country systems to deliver services to the population is challenged by post-conflict and fragile states where a State's capacity to manage its own affairs is low and scrutiny of the Government by the public is not possible. In case a government does not appear to make progress to improve these conditions, how can one improve effectiveness of Development Partners support? The RPF leading government introduced several reforms aimed at rebuilding the country, including the decentralization of power, the promotion of reconciliation, and the establishment of new institutions, such as the National Unity and Reconciliation Commission and the Gacaca courts. Since then, Rwanda has made significant progress in terms of governance, including in areas such as anti-corruption, gender equality, and social -economic development. However, critics have also raised from Human Right Watch Organizations (HRWO) concerns about the government's authoritarian tendencies, lack of political opposition, and human rights abuses. The current landscape of Rwanda's institutions reflects these complex historical developments, with a mix of centralized and decentralized power structures, a stronghold political ruling party, and efforts to promote reconciliation and development.

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“…The CBHI program aims to alleviate the devastating out-of-pocket medical expenses that affect the 85% of Ethiopians. The goals of CBHI include reducing catastrophic out-of-pocket costs, lowering financial obstacles, increasing the use of health services, enhancing quality of care, enhancing health equity, and enhancing sustainable health finance through mobilization of domestic resources ( 28 , 29 ).…”

Section: Introductionmentioning

confidence: 99%

Enrollment of reproductive age women in community-based health insurance: An evidence from 2019 Mini Ethiopian Demographic and Health Survey

Handebo

Demie

Woldeamanuel

et al. 2023

Front. Public Health

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BackgroundUniversal health coverage (UHC) is aimed at ensuring that everyone has access to high-quality healthcare without the risk of financial ruin. Community-based health insurance (CBHI) is one of the essential means to achieve the sustainable development goals (SDGs) global health priority of UHC. Thus, this study assessed health insurance enrollment and associated factors among reproductive age women in Ethiopia.MethodsWe computed the health insurance enrollment of reproductive-age women using secondary data from the recent Ethiopian Mini Demographic and Health Surveys (EMDHS) 2019. The EMDHS was a community-based cross-sectional study carried out in Ethiopia from March 21 to June 28, 2019. Cluster sampling with two stages was employed for the survey. The study comprised 8885 (weighted) reproductive-age women. STATA 14 was used for data processing and analysis. Bivariate and multivariable logistic regression analyses were conducted. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported and statistical significance was set at a value of p < 0.05.ResultsOf the 8,885 study participants, 3,835 (43.2, 95% CI; 42.1, 44.2%) of women had health insurance. Women aged 20–24 years, 25–29 years, and 30–34 years less likely to enroll in health insurance compared to their younger counterparts (15–19 years). Women living in rural areas, had greater than five family sizes, living with a female household head, and having more than five living children were negatively associated with enrollment in health insurance. Besides, health insurance enrollment among reproductive-age women is significantly affected by region and religious variation.ConclusionThe overall CBHI enrolment among reproductive-age women in Ethiopia was low. To achieve the SDGs of reducing maternal mortality ratio and neonatal mortality, improving reproductive-age women’s access to health insurance is essential. The national, regional, and local officals, policymakers, NGOs, program planners, and other supporting organizations working on improving health insurance enrollment of reproductive age women need to create awareness and support them based on these significant factors.

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

Cited by 12 publications

References 28 publications

Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis

Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis

Historical Development of Governance in Rwanda and How the Development Shaped the Landscape of Its Institutions

Enrollment of reproductive age women in community-based health insurance: An evidence from 2019 Mini Ethiopian Demographic and Health Survey

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