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The impact of Ethiopia’s pilot community based health insurance scheme on healthcare utilization and cost of care

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

Abstract

In recent years there has been a proliferation of Community Based Health Insurance (CBHI) schemes designed to enhance access to modern health care services and provide financial protection to workers in the informal and rural sectors. In June 2011, the Government of Ethiopia introduced a pilot CBHI scheme in rural parts of the country. This paper assesses the impact of the scheme on utilization of modern health care and the cost of accessing health care. It adds to the relatively small body of work that provides a rigorous evaluation of CBHI schemes. We find that enrolment leads to a 30 to 41 percent increase in utilization of outpatient care at public facilities, a 45 to 64 percent increase in the frequency of visits to public facilities and at least a 56 percent decline in the cost per visit to public facilities. The effects of the scheme on out-of-pocket spending are not as clear. The impact on utilization and costs combined with a high uptake rate of almost 50 percent within two years of scheme establishment, suggests that this scheme has the potential to meet the goal of universal access to health care.

Suggested Citation

  • Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Abebaw, D. & Alemu, G. & Bedi, A.S., 2014. "The impact of Ethiopia’s pilot community based health insurance scheme on healthcare utilization and cost of care," ISS Working Papers - General Series 77021, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    • Handle: RePEc:ems:euriss:77021
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    Cited by:

    1. Hsiao, William C. & Yip, Winnie, 2024. "Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?," Social Science & Medicine, Elsevier, vol. 345(C).
    2. Nathanael Ojong, 2019. "Healthcare Financing in Rural Cameroon," Societies, MDPI, vol. 9(4), pages 1-12, November.
    3. 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).
    4. Kalle Hirvonen & Anne Bossuyt & Remy Pigois, 2021. "Evidence from the Productive Safety Net Programme in Ethiopia: Complementarities between social protection and health policies," Development Policy Review, Overseas Development Institute, vol. 39(4), pages 532-547, July.
    5. Nshakira-Rukundo, Emmanuel & Mussa, Essa Chanie & Gerber, Nicolas & von Braun, Joachim, 2020. "Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda," Social Science & Medicine, Elsevier, vol. 245(C).
    6. Lavers, Tom, 2021. "Aiming for Universal Health Coverage through insurance in Ethiopia: State infrastructural power and the challenge of enrolment," Social Science & Medicine, Elsevier, vol. 282(C).
    7. Sayem Ahmed & Abdur Razzaque Sarker & Marufa Sultana & Sanchita Chakrovorty & Mohammad Wahid Ahmed & Farzana Dorin & Andrew J Mirelman & Ziaul Islam & Mohammad Hafizur Rahman & Louis W Niessen & Clas , 2018. "The impact of community-based health insurance on the utilization of medically trained healthcare providers among informal workers in Bangladesh," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-16, July.
    8. Xinxin Ma, 2022. "Social Insurances and Risky Financial Market Participation: Evidence from China," Emerging Markets Finance and Trade, Taylor & Francis Journals, vol. 58(10), pages 2957-2975, August.
    9. Mussa, Essa Chanie & Otchere, Frank & Vinci, Vincenzo & Reshad, Abduljelil & Palermo, Tia, 2021. "Linking poverty-targeted social protection and Community Based Health Insurance in Ethiopia: Enrolment, linkages, and gaps," Social Science & Medicine, Elsevier, vol. 286(C).
    10. Boutin, Delphine & Petifour, Laurene & Allard, Yvonne & Kontoubré, Souleymane & Ridde, Valéry, 2024. "Comprehensive Assessment of the Impact of Mandatory Community-Based Health Insurance in Burkina Faso," IZA Discussion Papers 17094, Institute of Labor Economics (IZA).

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    Keywords

    community based health insurance; outpatient healthcare utilization; out-of-pocket expenditure; Ethiopia;
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