IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v176y2017icp133-141.html
   My bibliography  Save this article

Uptake of health insurance and the productive safety net program in rural Ethiopia

Author

Listed:
  • Shigute, Zemzem
  • Mebratie, Anagaw D.
  • Sparrow, Robert
  • Yilma, Zelalem
  • Alemu, Getnet
  • Bedi, Arjun S.

Abstract

Due to lack of well-developed insurance and credit markets, rural families in Ethiopia are exposed to a range of covariate and idiosyncratic risks. In 2005, to deal with the consequences of covariate risks, the government implemented the Productive Safety Net Program (PSNP), and in 2011, to mitigate the financial consequences of ill-health, the government introduced a pilot Community Based Health Insurance (CBHI) Scheme. This paper explores whether scheme uptake and retention is affected by access to the PSNP. Based on household panel data and qualitative information, the analysis shows that participating in the PSNP increases the probability of CBHI uptake by 24 percentage points and enhances scheme retention by 10 percentage points. A large proportion of this effect may be attributed to explicit and implicit pressure applied by government officials on PSNP beneficiaries. Whether this is a desirable approach is debatable. Nevertheless, the results suggest that membership in existing social protection programs may be leveraged to spread new schemes and potentially accelerate poverty reduction efforts.

Suggested Citation

  • Shigute, Zemzem & Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2017. "Uptake of health insurance and the productive safety net program in rural Ethiopia," Social Science & Medicine, Elsevier, vol. 176(C), pages 133-141.
    • Handle: RePEc:eee:socmed:v:176:y:2017:i:c:p:133-141
    DOI: 10.1016/j.socscimed.2017.01.035
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953617300424
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2017.01.035?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2015. "Enrollment in Ethiopia’s Community-Based Health Insurance Scheme," World Development, Elsevier, vol. 74(C), pages 58-76.
    2. Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2014. "Dropping out of Ethiopia’s Community Based Health Insurance scheme," ISS Working Papers - General Series 76960, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    3. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance?: findings from an exploratory household survey in Senegal," LSE Research Online Documents on Economics 55820, London School of Economics and Political Science, LSE Library.
    4. Mebratie, A.D. & Sparrow, R.A. & Alemu, G. & Bedi, A.S., 2013. "Community-Based Health Insurance Schemes," ISS Working Papers - General Series 568, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    5. MR Rosenzweig, 2001. "Savings behaviour in low-income countries," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 17(1), pages 40-54, Spring.
    6. Stefan Dercon, 2002. "Income Risk, Coping Strategies, and Safety Nets," The World Bank Research Observer, World Bank, vol. 17(2), pages 141-166, September.
    7. Capuno, Joseph J. & Kraft, Aleli D. & Quimbo, Stella & Tan, Jr. Carlos R. & Wagstaff, Adam, 2014. "Effects of interventions to raise voluntary enrollment in a social health insurance scheme : a cluster randomized trial," Policy Research Working Paper Series 6893, The World Bank.
    8. Syed Abdul Hamid & Jennifer Roberts & Paul Mosley, 2011. "Can Micro Health Insurance Reduce Poverty? Evidence From Bangladesh," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 78(1), pages 57-82, March.
    9. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal," Social Science & Medicine, Elsevier, vol. 107(C), pages 78-88.
    10. Criel, Bart & Waelkens, Maria Pia, 2003. "Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?," Social Science & Medicine, Elsevier, vol. 57(7), pages 1205-1219, October.
    11. Wagstaff, Adam, 2007. "The economic consequences of health shocks: Evidence from Vietnam," Journal of Health Economics, Elsevier, vol. 26(1), pages 82-100, January.
    12. Abhijit Banerjee & Esther Duflo & Richard Hornbeck, 2014. "Bundling Health Insurance and Microfinance in India: There Cannot Be Adverse Selection If There Is No Demand," American Economic Review, American Economic Association, vol. 104(5), pages 291-297, May.
    13. Dong, Hengjin & De Allegri, Manuela & Gnawali, Devendra & Souares, Aurélia & Sauerborn, Rainer, 2009. "Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso," Health Policy, Elsevier, vol. 92(2-3), pages 174-179, October.
    14. Wagstaff, Adam & Nguyen, Ha Thi Hong & Dao, Huyen & Balesd, Sarah, 2014. "Encouraging health insurance for the informal sector : a cluster randomized trial," Policy Research Working Paper Series 6910, The World Bank.
    15. Kent Ranson, M. & Sinha, Tara & Chatterjee, Mirai & Acharya, Akash & Bhavsar, Ami & Morris, Saul S. & Mills, Anne J., 2006. "Making health insurance work for the poor: Learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India," Social Science & Medicine, Elsevier, vol. 62(3), pages 707-720, February.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Lavers, Tom, 2019. "Towards Universal Health Coverage in Ethiopia's ‘developmental state’? The political drivers of health insurance," Social Science & Medicine, Elsevier, vol. 228(C), pages 60-67.
    2. Biggeri, M. & Nannini, M. & Putoto, G., 2018. "Assessing the feasibility of community health insurance in Uganda: A mixed-methods exploratory analysis," Social Science & Medicine, Elsevier, vol. 200(C), pages 145-155.
    3. Tom Lavers, 2016. "Social protection in an aspiring ‘developmental state’: The political drivers of community-based health insurance in Ethiopia," Global Development Institute Working Paper Series esid-071-16, GDI, The University of Manchester.
    4. Tadesse, Getaw & Zewdie, Tadiwos, 2019. "Grants vs. credits for improving the livelihoods of ultra-poor: Evidence from Ethiopia," World Development, Elsevier, vol. 113(C), pages 320-329.
    5. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Abebaw, Degnet & Alemu, Getnet & Bedi, Arjun S., 2019. "The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care," Social Science & Medicine, Elsevier, vol. 220(C), pages 112-119.
    6. Hirvonen, Kalle & Bossuyt, Anne & Pigois, Remy, 2017. "Complementarities between social protection and health sector policies: Evidence from the Productive Safety Net Program in Ethiopia," ESSP working papers 112, International Food Policy Research Institute (IFPRI).
    7. Kalle Hirvonen & Anne Bossuyt & Remy Pigois, 2021. "Evidence from the Productive Safety Net Programme in Ethiopia: Complementarities between social protection and health policies," Development Policy Review, Overseas Development Institute, vol. 39(4), pages 532-547, July.
    8. Mussa, Essa Chanie & Otchere, Frank & Vinci, Vincenzo & Reshad, Abduljelil & Palermo, Tia, 2021. "Linking poverty-targeted social protection and Community Based Health Insurance in Ethiopia: Enrolment, linkages, and gaps," Social Science & Medicine, Elsevier, vol. 286(C).
    9. Dao, Amy, 2020. "What it means to say “I Don't have any money to buy health insurance” in rural Vietnam: How anticipatory activities shape health insurance enrollment," Social Science & Medicine, Elsevier, vol. 266(C).
    10. Lavers, Tom, 2021. "Aiming for Universal Health Coverage through insurance in Ethiopia: State infrastructural power and the challenge of enrolment," Social Science & Medicine, Elsevier, vol. 282(C).
    11. Shigute, Zemzem & Strupat, Christoph & Burchi, Francesco & Alemu, Getnet & Bedi, Arjun S., 2017. "The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia," IZA Discussion Papers 10939, Institute of Labor Economics (IZA).
    12. Kiros Tsegay & Hongzhong Fan & AM Priyangani Adikari & Hailay Shifare, 2021. "Does gender matter for household livelihood diversification in Ethiopia rural areas?," International Journal of Research in Business and Social Science (2147-4478), Center for the Strategic Studies in Business and Finance, vol. 10(6), pages 221-232, September.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Panda, P. & Chakraborty, A. & Raza, W.A. & Bedi, A.S., 2015. "Renewing membership in three community-based health insurance schemes in rural India," ISS Working Papers - General Series 608, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    2. David Mark Dror, 2018. "What Factors Affect Voluntary Uptake of Community-based Health Insurance Schemes in Lowand Middle-Income Countries? A Systematic Review and Meta-Analysis," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 14, pages 271-306, World Scientific Publishing Co. Pte. Ltd..
    3. Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2014. "Dropping out of Ethiopia’s Community Based Health Insurance scheme," ISS Working Papers - General Series 76960, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    4. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2015. "Enrollment in Ethiopia’s Community-Based Health Insurance Scheme," World Development, Elsevier, vol. 74(C), pages 58-76.
    5. Nshakira-Rukundo, Emmanuel & Mussa, Essa Chanie & Gerber, Nicolas & von Braun, Joachim, 2020. "Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda," Social Science & Medicine, Elsevier, vol. 245(C).
    6. Zemzem Shigute & Anagaw D. Mebratie & Robert Sparrow & Getnet Alemu & Arjun S. Bedi, 2020. "The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care," IJERPH, MDPI, vol. 17(22), pages 1-17, November.
    7. Thomas Rouyard & Yukichi Mano & Bocar Mamadou Daff & Serigne Diouf & Khadidiatou Fall Dia & Laetitia Duval & Josselin Thuilliez & Ryota Nakamura, 2022. "Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal," Post-Print halshs-03641124, HAL.
    8. Shigute, Zemzem & Strupat, Christoph & Burchi, Francesco & Alemu, Getnet & Bedi, Arjun S., 2017. "The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia," IZA Discussion Papers 10939, Institute of Labor Economics (IZA).
    9. Platteau, Jean-Philippe & De Bock, Ombeline & Gelade, Wouter, 2017. "The Demand for Microinsurance: A Literature Review," World Development, Elsevier, vol. 94(C), pages 139-156.
    10. Mussa, Essa Chanie & Otchere, Frank & Vinci, Vincenzo & Reshad, Abduljelil & Palermo, Tia, 2021. "Linking poverty-targeted social protection and Community Based Health Insurance in Ethiopia: Enrolment, linkages, and gaps," Social Science & Medicine, Elsevier, vol. 286(C).
    11. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2019. "Can information increase the understanding and uptake of insurance? Lessons from a randomized experiment in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 220(C), pages 102-111.
    12. Boutin, Delphine & Petifour, Laurene & Allard, Yvonne & Kontoubré, Souleymane & Ridde, Valéry, 2024. "Comprehensive Assessment of the Impact of Mandatory Community-Based Health Insurance in Burkina Faso," IZA Discussion Papers 17094, Institute of Labor Economics (IZA).
    13. Abdur Razzaque Sarker & Marufa Sultana & Sayem Ahmed & Rashidul Alam Mahumud & Alec Morton & Jahangir A.M. Khan, 2018. "Clients’ Experience and Satisfaction of Utilizing Healthcare Services in a Community Based Health Insurance Program in Bangladesh," IJERPH, MDPI, vol. 15(8), pages 1-14, August.
    14. Adeline Ajuaye & Boris Verbrugge & Jan Van Ongevalle & Patrick Develtere, 2019. "Understanding the limitations of “quasi‐mandatory” approaches to enrolment in community‐based health insurance: Empirical evidence from Tanzania," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1304-1318, October.
    15. Wood, Anna, 2023. "Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal," Social Science & Medicine, Elsevier, vol. 319(C).
    16. Chantal Herberholz & Wael Ahmed Fakihammed, 2017. "Determinants of Voluntary National Health Insurance Drop-Out in Eastern Sudan," Applied Health Economics and Health Policy, Springer, vol. 15(2), pages 215-226, April.
    17. Dao, Amy, 2020. "What it means to say “I Don't have any money to buy health insurance” in rural Vietnam: How anticipatory activities shape health insurance enrollment," Social Science & Medicine, Elsevier, vol. 266(C).
    18. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal," Social Science & Medicine, Elsevier, vol. 107(C), pages 78-88.
    19. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2017. "Nudging Households to Take Up Health Insurance: Evidence from a Randomized Experiment in Burkina Faso," IZA Discussion Papers 10744, Institute of Labor Economics (IZA).
    20. Neely, Abigail H. & Ponshunmugam, Arunsrinivasan, 2019. "A qualitative approach to examining health care access in rural South Africa," Social Science & Medicine, Elsevier, vol. 230(C), pages 214-221.

    More about this item

    Keywords

    Ethiopia; Productive safety net program; Community based health insurance; Uptake of health insurance;
    All these keywords.

    JEL classification:

    • J65 - Labor and Demographic Economics - - Mobility, Unemployment, Vacancies, and Immigrant Workers - - - Unemployment Insurance; Severance Pay; Plant Closings
    • J48 - Labor and Demographic Economics - - Particular Labor Markets - - - Particular Labor Markets; Public Policy
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:176:y:2017:i:c:p:133-141. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.