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

Author

Listed:
  • 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," The World Bank Economic Review, World Bank, 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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    File URL: http://hdl.handle.net/10.1093/wber/lhv009
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    1. Emily Gustafsson-Wright & Gosia Popławska & Zlata Tanović & Jacques Gaag, 2018. "The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 221-276, September.
    2. Stéphanie Degroote & Valery Ridde & Manuela Allegri, 2020. "Health Insurance in Sub-Saharan Africa: A Scoping Review of the Methods Used to Evaluate its Impact," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 825-840, December.
    3. Andinet Woldemichael & Daniel Gurara & Abebe Shimeles, 2019. "The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda," IMF Working Papers 2019/038, International Monetary Fund.
    4. Wakuma Akafu Eseta & Shimeles Ololo Sinkie, 2022. "Factors affecting households’ trust in the community based health insurance scheme in Ethiopia," PLOS Global Public Health, Public Library of Science, vol. 2(5), pages 1-14, May.
    5. 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 of Labor Economics (IZA).
    6. Fitsum Meseret Legesse & Akalework Mengesha Babanto, 2023. "Factors Associated With the Use of Traditional Medicine in Wolaita Zone, Southern Ethiopia," SAGE Open, , vol. 13(1), pages 21582440231, February.
    7. Nathanael Ojong, 2019. "Healthcare Financing in Rural Cameroon," Societies, MDPI, vol. 9(4), pages 1-12, November.
    8. Zelalem Yilma & Owen O’Donnell & Anagaw Mebratie & Getnet Alemu & Arjun S. Bedi, 2018. "Subjective Expectations of Medical Expenditures and Insurance in Rural Ethiopia," Contributions to Economic Analysis, in: Health Econometrics, volume 127, pages 23-55, Emerald Group Publishing Limited.
    9. Ahmed Tahir & Abdulahi Omer Abdilahi & Abdifatah Elmi Farah, 2022. "Pooled coverage of community based health insurance scheme enrolment in Ethiopia, systematic review and meta-analysis, 2016–2020," Health Economics Review, Springer, vol. 12(1), pages 1-10, December.
    10. 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).
    11. 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.
    12. Koloma, Yaya, 2021. "Impact of Mutual Health Insurance on Urban Households Health Expenses and Vulnerability in Burkina Faso," EconStor Preprints 234465, ZBW - Leibniz Information Centre for Economics.
    13. 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).
    14. Yikeber Abebaw Moyehodie & Solomon Sisay Mulugeta & Seyifemickael Amare Yilema, 2022. "The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia," PLOS ONE, Public Library of Science, vol. 17(10), pages 1-14, October.
    15. Noemi Kreif & Andrew Mirelman & Rodrigo Moreno-Serra & Taufik Hidayat, & Karla DiazOrdaz & Marc Suhrcke, 2020. "Who benefits from health insurance? Uncovering heterogeneous policy impacts using causal machine learning," Working Papers 173cherp, Centre for Health Economics, University of York.
    16. 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).
    17. Boutin, Delphine & Petitfour, Laurène & Allard, Yvonne & Kountoubré, Souleymane & Ridde, Valéry, 2025. "Comprehensive assessment of the impact of mandatory community-based health insurance in Burkina Faso," Social Science & Medicine, Elsevier, vol. 371(C).
    18. Misganaw Teshager Abeje & Atsushi Tsunekawa & Nigussie Haregeweyn & Zemen Ayalew & Zerihun Nigussie & Daregot Berihun & Enyew Adgo & Asres Elias, 2020. "Multidimensional Poverty and Inequality: Insights from the Upper Blue Nile Basin, Ethiopia," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 149(2), pages 585-611, June.
    19. Rabbani, Atonu & Mehareen, Jeenat & Chowdhury, Imran Ahmed & Sarker, Malabika, 2022. "Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment," Social Science & Medicine, Elsevier, vol. 292(C).
    20. Raphaël Cottin, 2018. "Free health care for the poor: a good way to achieve universal health coverage? Evidence from Morocco," Working Papers DT/2018/16, DIAL (Développement, Institutions et Mondialisation).
    21. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.

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