IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0205972.html
   My bibliography  Save this article

The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study

Author

Listed:
  • Asnakew Molla Mekonen
  • Measho Gebreslassie Gebregziabher
  • Alemayehu Shimeka Teferra

Abstract

Introduction: Moving towards the goal of universal health coverage requires strengthening service delivery and overcoming significant financial barriers. The Government of Ethiopia is rolling out community based health insurance to protect the rural community from high out of pocket health expenditure and improve health service utilization. We investigated the effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia. Methods: A community based cross sectional study was conducted. A Multi stage sampling technique was used to get a total of 454 (224 insured and 230 uninsured) households. The data were entered using EPI info version 7 and analyzed using SPSS version 20 and STATA version 13 for binary logistic regression analysis and propensity score matching analysis respectively. Wealth status of the households was computed by Principal Component Analysis (PCA). A multivariable logistic regression analysis was done to identify the predictors of catastrophic health expenditure. Propensity score matching analysis was used to determine the effect of community based health insurance on catastrophic health expenditure. The average treatment effect on the treated (ATT) was calculated to compare the means of outcomes across insured and uninsured households. Results: A total of 454 household heads were included in the study, making a response rate of 91.2%.The total level of catastrophic health expenditure was found to be 20%. Among the households with catastrophic health expenditure, 4.41% were insured, whereas the remaining 15.64% were noninsured. Insured households (AOR = 0.19, 95% CI: 0.11–0.34), rich households (AOR = 1.98; 95% CI: 1.07–3.66), having member with chronic illness (AOR = 2.13, 95% CI: 1.01–4.51) and having member encountered any illness during the past 3 months (AOR = 2.44, 95% CI: 1.35–4.40) were statistically associated with catastrophic health expenditure. Community based health insurance contributed to 23.2% (t = -5.94) (95% CI: -0.31_-0.15) reduction of catastrophic health expenditure. Conclusion: The overall level of catastrophic health expenditure was high among noninsured households. Community based health insurance has significant financial protection from catastrophic health expenditure in northeast Ethiopia. Thus, the government need to scale up community based health insurance to protect the noninsured households from catastrophic health expenditure.

Suggested Citation

  • Asnakew Molla Mekonen & Measho Gebreslassie Gebregziabher & Alemayehu Shimeka Teferra, 2018. "The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-13, October.
    • Handle: RePEc:plo:pone00:0205972
    DOI: 10.1371/journal.pone.0205972
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205972
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0205972&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0205972?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
    ---><---

    References listed on IDEAS

    as
    1. Gnawali, Devendra Prasad & Pokhrel, Subhash & Sié, Ali & Sanon, Mamadou & De Allegri, Manuela & Souares, Aurélia & Dong, Hengjin & Sauerborn, Rainer, 2009. "The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso," Health Policy, Elsevier, vol. 90(2-3), pages 214-222, May.
    2. Ye Li & Qunhong Wu & Chaojie Liu & Zheng Kang & Xin Xie & Hui Yin & Mingli Jiao & Guoxiang Liu & Yanhua Hao & Ning Ning, 2014. "Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    3. Wameq A. Raza & Ellen van de Poel & Arjun Bedi & Frans Rutten, 2016. "Impact of Community‐based Health Insurance on Access and Financial Protection: Evidence from Three Randomized Control Trials in Rural India," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 675-687, June.
    4. Sarah Alkenbrack & Magnus Lindelow, 2015. "The Impact of Community‐Based Health Insurance on Utilization and Out‐of‐Pocket Expenditures in Lao People's Democratic Republic," Health Economics, John Wiley & Sons, Ltd., vol. 24(4), pages 379-399, April.
    5. Xuedan You & Yasuki Kobayashi, 2011. "Determinants of out-of-pocket health expenditure in China," Applied Health Economics and Health Policy, Springer, vol. 9(1), pages 39-49, January.
    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. Phuong Huu Khiem & Yu-Chen Kuo, 2022. "Health insurance reform impact on children’s educational attainment: evidence from Vietnam," Review of Economics of the Household, Springer, vol. 20(4), pages 1255-1285, December.
    2. Abdul-Aziz Seidu, 2020. "Mixed effects analysis of factors associated with barriers to accessing healthcare among women in sub-Saharan Africa: Insights from demographic and health surveys," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-16, November.
    3. Nguyen Thi Thu Thuong & Yme Van Den Berg & Tran Quang Huy & Do Anh Tai & Bui Nu Hoang Anh, 2021. "Determinants of catastrophic health expenditure in Vietnam," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 316-333, March.
    4. Dawit Nageso & Kebede Tefera & Keneni Gutema, 2020. "Enrollment in community based health insurance program and the associated factors among households in Boricha district, Sidama Zone, Southern Ethiopia; a cross-sectional study," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-14, June.

    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. 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.
    2. 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).
    3. 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.
    4. Ijeoma Nkem Okedo‐Alex & Ifeyinwa Chizoba Akamike & Obumneme Benaiah Ezeanosike & Chigozie Jesse Uneke, 2019. "A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1387-1404, October.
    5. Macha, Raphael Rasiel, 2015. "Community Based Health Insurance Schemes and Protection of the Rural Poor: Empirical evidence from Tanzania," African Journal of Economic Review, African Journal of Economic Review, vol. 3(2), July.
    6. Kuangnan Fang & BenChang Shia & Shuangge Ma, 2012. "Health Insurance Coverage and Impact: A Survey in Three Cities in China," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-8, June.
    7. Kuangnan Fang & Yefei Jiang & BenChang Shia & Shuangge Ma, 2012. "Impact of Illness and Medical Expenditure on Household Consumptions: A Survey in Western China," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-8, December.
    8. Steven F. Koch, 2017. "Does the Equivalence Scale Matter? Equivalence and Out-of-Pocket Payments," Working Papers 687, Economic Research Southern Africa.
    9. 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.
    10. Maryam Bigdeli & Bart Jacobs & Chean Rithy Men & Kristine Nilsen & Wim Van Damme & Bruno Dujardin, 2016. "Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    11. Bukari, Chei & Broermann, Shanaz & Okai, Davidson, 2021. "Energy poverty and health expenditure: Evidence from Ghana," Energy Economics, Elsevier, vol. 103(C).
    12. Koris, Roshanim & Mohamed Nor, Norashidah & Haron, Sharifah Azizah & Hamid, Tengku Aizan & Aljunid, Syed Mohamed & Muhammad Nur, Amrizal & Ismail, Normaz Wana & Shafie, Asrul Akmal & Yusuff, Suraya & , 2019. "The Cost of Healthcare among Malaysian Community-Dwelling Elderly," Jurnal Ekonomi Malaysia, Faculty of Economics and Business, Universiti Kebangsaan Malaysia, vol. 53(1), pages 89-103.
    13. Nadeem A. Burney & Mohammad Alenezi & Nadia Al-Musallam & Ahmed Al-Khayat, 2016. "The demand for medical care services: evidence from Kuwait based on households’ out-of-pocket expenses," Applied Economics, Taylor & Francis Journals, vol. 48(28), pages 2636-2650, June.
    14. Sodokin, Koffi & Djafon, Joseph Kokouvi & Dandonougbo, Yevessé & Akakpo, Afi & Couchoro, Mawuli K. & Agbodji, Akoété Ega, 2023. "Technological change, completeness of financing microstructures, and impact on well-being and income inequality," Telecommunications Policy, Elsevier, vol. 47(6).
    15. Getahun Gebre Bogale & Ayesheshim Muluneh Kassa, 2022. "Factors associated with catastrophic health care expenditure in South Wollo province, Ethiopia: A cross‐sectional study," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(3), pages 1694-1707, May.
    16. Robyn, Paul Jacob & Bärnighausen, Till & Souares, Aurélia & Traoré, Adama & Bicaba, Brice & Sié, Ali & Sauerborn, Rainer, 2014. "Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study," Social Science & Medicine, Elsevier, vol. 108(C), pages 223-236.
    17. Slim Haddad & Valery Ridde & Ismaelou Yacoubou & Geneviève Mák & Michel Gbetié, 2012. "An Evaluation of the Outcomes of Mutual Health Organizations in Benin," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-8, October.
    18. Acharya, Arnab & Vellakkal, Sukumar & Taylor Fiona & Masset Edoardo & Satija, Ambika & Burke, Margaret & Ebrahim, Shah, 2013. "The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review," Policy Research Working Paper Series 6324, The World Bank.
    19. Gerson Javier Pérez-Valbuena & Alejandro Silva-Ureña, 2017. "Una mirada a los gastos de bolsillo en salud para Colombia," Chapters, in: Jaime Bonet & Karelys Guzmán-Finol & Lucas Wilfried Hahn-De-Castro (ed.), La salud en Colombia: una perspectiva regional, chapter 11, pages 365-404, Banco de la Republica de Colombia.
    20. Ziyad S. Almalki & Abdullah K. Alahmari & Nasser Alqahtani & Abdulaziz Ibrahim Alzarea & Ahmed M. Alshehri & Abdulrahman M. Alruwaybiah & Bader A. Alanazi & Abdulhadi M. Alqahtani & Nehad J. Ahmed, 2022. "Households’ Direct Economic Burden Associated with Chronic Non-Communicable Diseases in Saudi Arabia," IJERPH, MDPI, vol. 19(15), pages 1-14, August.

    More about this item

    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:plo:pone00:0205972. 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: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    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.