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The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia

Author

Listed:
  • Shigute, Zemzem

    (ISS, Erasmus University Rotterdam)

  • Strupat, Christoph

    (German Development Institute)

  • Burchi, Francesco

    (German Development Institute)

  • Alemu, Getnet

    (University of Addis Ababa, Ethiopia)

  • Bedi, Arjun S.

    (ISS, Erasmus University Rotterdam)

Abstract

Rural households in Ethiopia are exposed to a variety of covariate and idiosyncratic risks. In 2005, the Ethiopian government introduced the Productive Safety Net Program (PSNP) and in 2011 launched the Community Based Health Insurance Scheme (CBHI). This paper analyses the interaction between the two schemes and their joint effect on health care utilization, labor supply, asset accumulation and borrowing. The empirical analysis relies on three rounds of individual-level panel data collected in 2011, 2012 and 2013 and on several rounds of qualitative work. We find that individuals covered by both programs, as opposed to neither, are 5 percentage points more likely to use outpatient care and are 21 percentage points more likely to participate in off-farm work. Furthermore, participation in both programs is associated with a 5 percent increase in livestock, the main household asset, and a 27 percent decline in debt. These results suggest that at least in Ethiopia bundling of interventions enhances protection against multiple risks and shows the potential of linked social protection schemes.

Suggested Citation

  • 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).
    • Handle: RePEc:iza:izadps:dp10939
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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.
    2. Dercon, Stefan, 2004. "Growth and shocks: evidence from rural Ethiopia," Journal of Development Economics, Elsevier, vol. 74(2), pages 309-329, August.
    3. Jensen, Nathaniel D. & Barrett, Christopher B. & Mude, Andrew G., 2017. "Cash transfers and index insurance: A comparative impact analysis from northern Kenya," Journal of Development Economics, Elsevier, vol. 129(C), pages 14-28.
    4. repec:idb:brikps:59558 is not listed on IDEAS
    5. Cristian C. Baeza & Truman G. Packard, 2006. "Beyond Survival : Protecting Households from Health Shocks in Latin America," World Bank Publications - Books, The World Bank Group, number 7120, December.
    6. Salvatore Di Falco & Marcella Veronesi & Mahmud Yesuf, 2011. "Does Adaptation to Climate Change Provide Food Security? A Micro-Perspective from Ethiopia," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 93(3), pages 825-842.
    7. Andersson, Camilla & Mekonnen, Alemu & Stage, Jesper, 2011. "Impacts of the Productive Safety Net Program in Ethiopia on livestock and tree holdings of rural households," Journal of Development Economics, Elsevier, vol. 94(1), pages 119-126, January.
    8. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Degnet Abebaw & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2014. "Coping with shocks in rural Ethiopia," Journal of Development Studies, Taylor & Francis Journals, vol. 50(7), pages 1009-1024, July.
    9. 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.
    10. Bender, Katja, 2011. "Health Financing Mechanisms, Access to Health and Economic Growth," IEE Working Papers 192, Ruhr University Bochum, Institute of Development Research and Development Policy (IEE).
    11. Jensen, Nathaniel & Barrett, Christopher B. & Mude, Andrew, 2014. "Index Insurance and Cash Transfers: A Comparative Analysis from Northern Kenya," MPRA Paper 61372, University Library of Munich, Germany.
    12. Truman G. Packard & Cristian C. Baeza, 2006. "Beyond Survival: Protecting Households from Health Shocks in Latin America," IDB Publications (Books), Inter-American Development Bank, number 59558, February.
    13. Paul Gertler, 2004. "Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA's Control Randomized Experiment," American Economic Review, American Economic Association, vol. 94(2), pages 336-341, May.
    14. Subbarao,Kalanidhi, 2003. "Systemic shocks and social protection : role and effectiveness of public works programs," Policy Research Working Paper Series 25606, The World Bank.
    15. Syed Abdul Hamid & Jennifer Roberts & Paul Mosley, 2011. "Can Micro Health Insurance Reduce Poverty? Evidence From Bangladesh," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 78(1), pages 57-82, March.
    16. Jere R. Behrman & John Hoddinott, 2005. "Programme Evaluation with Unobserved Heterogeneity and Selective Implementation: The Mexican PROGRESA Impact on Child Nutrition," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 67(4), pages 547-569, August.
    17. Sudhanshu Handa & Benjamin Davis & Marco Stampini & Paul Winters, 2010. "Heterogeneous treatment effects in conditional cash transfer programmes: assessing the impact of Progresa on agricultural households," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 2(3), pages 320-335.
    18. Daniel Gilligan & John Hoddinott & Alemayehu Seyoum Taffesse, 2009. "The Impact of Ethiopia's Productive Safety Net Programme and its Linkages," Journal of Development Studies, Taylor & Francis Journals, vol. 45(10), pages 1684-1706.
    19. repec:zbw:rwirep:0432 is not listed on IDEAS
    20. 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.
    21. Klohn, Florian & Strupat, Christoph, 2013. "Crowding out of Solidarity? – Public Health Insurance versus Informal Transfer Networks in Ghana," Ruhr Economic Papers 432, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    22. José A. Pagán & Andrea Puig & Beth J. Soldo, 2007. "Health insurance coverage and the use of preventive services by Mexican adults," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1359-1369.
    23. Ravallion, Martin, 1991. "Reaching the Rural Poor through Public Employment: Arguments, Evidence, and Lessons from South Asia," The World Bank Research Observer, World Bank, vol. 6(2), pages 153-175, July.
    24. Abhijit Banerjee & Esther Duflo & Richard Hornbeck, 2014. "Bundling Health Insurance and Microfinance in India: There Cannot Be Adverse Selection If There Is No Demand," American Economic Review, American Economic Association, vol. 104(5), pages 291-297, May.
    25. K. Subbarao, 1997. "Public Works as an Anti-Poverty Program: An Overview of Cross-Country Experience," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 79(2), pages 678-683.
    26. Subbarao, Kalanidhi, 2003. "Systemic shocks and social protection : role and effectiveness of public works programs," Social Protection and Labor Policy and Technical Notes 25606, The World Bank.
    27. José A. Pagán & Andrea Puig & Beth J. Soldo, 2007. "Health insurance coverage and the use of preventive services by Mexican adults," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1359-1369, December.
    28. Kent Ranson, M. & Sinha, Tara & Chatterjee, Mirai & Acharya, Akash & Bhavsar, Ami & Morris, Saul S. & Mills, Anne J., 2006. "Making health insurance work for the poor: Learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India," Social Science & Medicine, Elsevier, vol. 62(3), pages 707-720, February.
    29. Limwattananon, Supon & Neelsen, Sven & O'Donnell, Owen & Prakongsai, Phusit & Tangcharoensathien, Viroj & van Doorslaer, Eddy & Vongmongkol, Vuthiphan, 2015. "Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand," Journal of Public Economics, Elsevier, vol. 121(C), pages 79-94.
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    Cited by:

    1. World Bank Group & U.K. Department of International Development, 2019. "Poverty and Vulnerability in the Ethiopian Lowlands," World Bank Publications - Reports 33422, The World Bank Group.
    2. Strupat, Christoph & Klohn, Florian, 2018. "Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana," World Development, Elsevier, vol. 104(C), pages 212-221.

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    More about this item

    Keywords

    Productive Safety Net Program; Community Based Health Insurance Scheme; Ethiopia; joint effect;
    All these keywords.

    JEL classification:

    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development

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