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Impact of Ethiopia's Community Based Health Insurance on Household Economic Welfare

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  • Zelalem Yilma
  • Anagaw Mebratie
  • Robert Sparrow
  • Marleen Dekker
  • Getnet Alemu
  • Arjun S. Bedi

Abstract

In 2011, in an attempt to increase access to health care and reduce household vulnerability to out-of-pocket health expenditure, the Government of Ethiopia launched a Community-Based Health Insurance Scheme (CBHI). This paper uses three rounds of household survey data, collected before and after the introduction of the CBHI pilot, to assess the impact of the scheme on household consumption, income, indebtedness, and livestock holdings. We find that enrollment leads to a 5 percentage point—or 13%—decline in the probability of borrowing and is associated with an increase in household income. There is no evidence that enrolling in the scheme affects consumption or livestock holdings. Our results show that the scheme reduces reliance on potentially harmful coping responses such as borrowing. This paper adds to the relatively small body of work that rigorously evaluates the impact of CBHI schemes on economic welfare.

Suggested Citation

  • Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2015. "Impact of Ethiopia's Community Based Health Insurance on Household Economic Welfare," World Bank Economic Review, World Bank Group, vol. 29(suppl_1), pages 164-173.
  • Handle: RePEc:oup:wbecrv:v:29:y:2015:i:suppl_1:p:s164-s173.
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    References listed on IDEAS

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    1. Smith, Kimberly V. & Sulzbach, Sara, 2008. "Community-based health insurance and access to maternal health services: Evidence from three West African countries," Social Science & Medicine, Elsevier, vol. 66(12), pages 2460-2473, June.
    2. Shimeles, Abebe, 2010. "Community based health insurance schemes in Africa: The case of Rwanda," Working Papers in Economics 463, University of Gothenburg, Department of Economics.
    3. Dekker, Marleen & Wilms, Annegien, 2010. "Health Insurance and Other Risk-Coping Strategies in Uganda: The Case of Microcare Insurance Ltd," World Development, Elsevier, vol. 38(3), pages 369-378, March.
    4. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Degnet Abebaw & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2014. "Coping with shocks in rural Ethiopia," Journal of Development Studies, Taylor & Francis Journals, vol. 50(7), pages 1009-1024, July.
    5. Robert Sparrow & Ellen Van Poel & Gracia Hadiwidjaja & Athia Yumna & Nila Warda & Asep Suryahadi, 2014. "Coping With The Economic Consequences Of Ill Health In Indonesia," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 719-728, June.
    6. Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412.
    7. Assefa Admassie & Degnet Abebaw & Andinet Woldemichael, 2009. "Impact evaluation of the Ethiopian Health Services Extension Programme," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 1(4), pages 430-449.
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    Cited by:

    1. Woldemichael, Andinet & Gurara, Daniel Zerfu & Shimeles, Abebe, 2016. "Community-Based Health Insurance and Out-of-Pocket Healthcare Spending in Africa: Evidence from Rwanda," IZA Discussion Papers 9922, Institute for the Study of Labor (IZA).
    2. Zelalem Yilma & Owen O’Donnell & Anagaw Mebratie & Getnet Alemu & Arjun S. Bedi, 2015. "Subjective Expectations of Medical Expenditures and Insurance in Rural Ethiopia," Tinbergen Institute Discussion Papers 15-120/V, Tinbergen Institute.
    3. 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).
    4. 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 for the Study of Labor (IZA).

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