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Enrolment in Ethiopia’s Community Based Health Insurance Scheme

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

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.

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Paper provided by International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague in its series ISS Working Papers - General Series with number 50221.

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Date of creation: 20 Dec 2013
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Handle: RePEc:ems:euriss:50221
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  1. Zhang, Licheng & Wang, Hong, 2008. "Dynamic process of adverse selection: Evidence from a subsidized community-based health insurance in rural China," Social Science & Medicine, Elsevier, vol. 67(7), pages 1173-1182, October.
  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. 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.
  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.
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