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Enrolment in Ethiopia’s Community Based Health Insurance Scheme

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  • Derseh, A.
  • Sparrow, R.A.
  • Debebe, Z.Y.
  • Alemu, G.
  • Bedi, A.S.

Abstract

In June 2011, the Government of Ethiopia rolled out a pilot Community Based Health Insurance (CBHI) scheme. This paper assesses scheme uptake. We examine whether the scheme is inclusive, the role of health status in inducing enrolment and the effect of the quality of health care on uptake. By December 2012, scheme uptake had reached an impressive 45.5 percent of target households. We find that a household’s socioeconomic status does not inhibit uptake and the most food-insecure households are substantially more likely to enrol. Recent illnesses, incidence of chronic diseases and self-assessed health status do not induce enrolment, while there is a positive link between past expenditure on outpatient care and enrolment. A relative novelty is the identification of the quality of health care on enrolment. We find that the availability of medical equipment and waiting time to see a medical professional play a substantial role in determining enrolment. Focus group discussions raise concerns about the behaviour of health care providers who tend to provide preferential treatment to uninsured households. Nevertheless, the start of the pilot scheme has been impressive and despite some concerns, almost all insured households indicate their intention to renew membership and more than half of uninsured households indicate a desire to enrol. While this augurs well, the estimates suggest that expanding uptake will require continued investments in the quality of health care.

Suggested Citation

  • Derseh, A. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2013. "Enrolment in Ethiopia’s Community Based Health Insurance Scheme," ISS Working Papers - General Series 50221, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
  • Handle: RePEc:ems:euriss:50221
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    References listed on IDEAS

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    Cited by:

    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, pages 58-76.
    2. Raza, Wameq & van de Poel, Ellen & Panda, Pradeep, 2016. "Analyses of enrolment, dropout and effectiveness of RSBY in northern rural India," MPRA Paper 70081, University Library of Munich, Germany.
    3. 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.
    4. 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, pages 133-141.
    5. 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).
    6. 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.
    7. 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, pages 133-141.

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    Keywords

    communit based health insurance; adverse selection; social exclusion; Ethiopia;

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