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Dropping out of Ethiopia’s Community Based Health Insurance scheme

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

Abstract

Low contract renewal rates have been identified as one of the challenges facing the development of community based health insurance schemes (CBHI). This paper uses longitudinal household survey data to examine dropout in the case of Ethiopia’s pilot CBHI scheme, which saw enrolment increases from 41 percent one year after inception to 48 percent a year later. An impressive 82 percent of those who enrolled in the first year renew their subscriptions, while 25 percent who had not enrolled join the scheme. The analysis shows that socio-economic status, a greater understanding of health insurance, and experience with and knowledge of the CBHI scheme reduce dropout. While there are concerns about the quality of care and the treatment meted out to the insured by providers, the overall picture is that returns from the scheme are overwhelmingly positive. For the bulk of households, premiums do not seem to be onerous, basic understanding of health insurance is high and almost all those who are currently enrolled signal their desire to renew contracts.

Suggested Citation

  • 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.
  • Handle: RePEc:ems:euriss:76960
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    References listed on IDEAS

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    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, vol. 74(C), pages 58-76.
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    5. 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.
    6. Joseph Mensah & Joseph R. Oppong & Christoph M. Schmidt, 2010. "Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 95-106, September.
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    9. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal," Social Science & Medicine, Elsevier, vol. 107(C), pages 78-88.
    10. Dong, Hengjin & De Allegri, Manuela & Gnawali, Devendra & Souares, Aurélia & Sauerborn, Rainer, 2009. "Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso," Health Policy, Elsevier, vol. 92(2-3), pages 174-179, October.
    11. Criel, Bart & Waelkens, Maria Pia, 2003. "Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?," Social Science & Medicine, Elsevier, vol. 57(7), pages 1205-1219, October.
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    Cited by:

    1. 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).
    2. 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, vol. 176(C), pages 133-141.
    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.

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