The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care

Mebratie, Anagaw Derseh; Sparrow, Robert; Yilma, Zelalem; Abebaw, Degnet; Alemu, Getnet; Bedi, Arjun S.

doi:10.1016/j.socscimed.2018.11.003

Cited by 54 publications

(70 citation statements)

References 13 publications

(17 reference statements)

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“…Health insurance was often commented as justification for liberally visiting health centers if the child became ill ("there is no reason not to visit the health center"). Since 2010, Ethiopia has implemented and scaled up community-based and social health insurance in rural areas [30,31]. This may explain why families in this study rarely mentioned finances as a barrier to accessing the health center.…”

Section: Discussionmentioning

confidence: 85%

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Asfaha

Comeau

Spangler

et al. 2020

BMC Health Serv Res

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Background: In Ethiopia, neonatal mortality accounts for approximately 54% of under-five deaths with the majority of these deaths driven by infections. Possible Severe Bacterial Infection (PSBI) in neonates is a syndromic diagnosis that non-clinical health care providers use to identify and treat newborns with signs of sepsis. In low-and middleincome countries, referral to a hospital may not be feasible due to transportation, distance or finances. Growing evidence suggests health extension workers (HEWs) can identify and manage PSBI at the community level when referral to a hospital is not possible. However, community-based PSBI care strategies have not been widely scaledup. This study aims to understand general determinants of household-level care as well as household care seeking and decision-making strategies for neonatal PSBI symptoms. Methods: We conducted eleven focus group discussions (FGDs) to explore illness recognition and care seeking intentions from four rural kebeles in Amhara, Ethiopia. FGDs were conducted among mothers, fathers and households with recruitment stratified among households that have had a newborn with at least one symptom of PSBI (Symptomatic Group), and households that have had a newborn regardless of the child's health status (Community Group). Data were thematically analyzed using MAXQDA software. Results: Mothers were described as primary caretakers of the newborn and were often appreciated for making decisions for treatment, even when the father was not present. Type of care accessed was often dependent on conceptualization of the illness as simple or complex. When symptoms were not relieved with clinical care, or treatments at facilities were perceived as ineffective, alternative methods were sought. Most participants identified the health center as a reliable facility. While designed to be the first point of access for primary care, health posts were not mentioned as locations where families seek clinical treatment.

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Section: Discussionmentioning

confidence: 85%

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Asfaha

Comeau

Spangler

et al. 2020

BMC Health Serv Res

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“…Accordingly, we employed the propensity score matching (PSM) method, which was introduced by Rosenbaum and Rubin 33 to address this problem. This method was applied in a number of studies such as Mebratie et al, 24 Gustafsson-Wright et al, 34 Palmer, 35 Nguyen 21 and Axelson et al 27 The PSM builds a statistical comparison group based on the likelihood of involving in the HI programme, depending on the observed traits. 23 The idea of PSM is to find individuals not participating in the programme whose characteristics are similar to those of the participants.…”

Section: Discussionmentioning

confidence: 99%

Impact of health insurance on healthcare utilisation patterns in Vietnam: a survey-based analysis with propensity score matching method

Thuong

2020

BMJ Open

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ObjectivesThe study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups.Design/settingSecondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted.ParticipantsA total of 4900 individuals who reported using healthcare services are analysed.Outcomes measureNumbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year.ResultsThe result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics.ConclusionOur findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level.

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“…Hence, with no any risk pooling mechanism, households face impoverishment from OOP expense [26]. By avoiding OOP payment, CBHI can improve access, overall quality of service and health care utilization [27,28].…”

Section: Introductionmentioning

confidence: 99%

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

Bayked¹,

Kahissay²,

Workneh³

2019

Preprint

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Background: The goal of health care financing in Ethiopia has been to achieve universal health care coverage by minimizing the catastrophic out of pocket health service expenditure. Even though the performance was not as planned, the promising strategy to achieve universal health care coverage in the informal sector was community based health insurance which was expected to cover more than 83 % of the population. So, we systematically reviewed determinants of community based health insurance utilization in Ethiopia. Methods: We searched DOAJ, EconBiz, ERIC, Google Scholar, Oxford Journals, PubMed, SpringerLink, Europe PMC, Microsoft Academic Search, OAIster and AJ including various relevant websites by March 9 to 10, 2019. We included articles regardless of their publication status with both quantitative and qualitative approaches. Results: The factors determining community based health insurance utilization in Ethiopia were found to be associated with supply side, health facility, demographic and socioeconomic predictors. Among demographic and socio-economic factors, the report of the studies regarding to gender and age was not consistent. However income, education, community participation, marriage, occupation and family size were found to be significant predictors and were positively related with the scheme’s utilization. With respect to health status and health service related factors; illness experience, benefit package, awareness level, previous out of pocket expenditure for health care service and health service status (quality, adequacy, efficiency and coverage) were significantly and positively related but premium amount, self-rated health status and bureaucratic complexity were found to be negative predictors. Conclusion: To achieve universal health care coverage through community based health insurance, it is advisable that special attention should be given to income level, education, community participation, marriage, family size, benefit package, awareness level and health service quality, premium amount and bureaucratic or governance issue.

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The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care

Cited by 54 publications

References 13 publications

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

Impact of health insurance on healthcare utilisation patterns in Vietnam: a survey-based analysis with propensity score matching method

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

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