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Title
The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care |
Full text
http://hdl.handle.net/1885/264534; https://openresearch-repository.anu.edu.au/bitstream/1885/264534/3/01_Mebratie_The_impact_of_Ethiopia%2527s_pilot_2019.pdf.jpg |
Date
2019 |
Author(s)
Mebratie, Anagaw; Sparrow, Robert; Yilma, Zelalem; Abebaw, Degnet; Alemu, Getnet; Bedi, Arjun |
Abstract
In June 2011, the Government of Ethiopia introduced a pilot Community Based Health Insurance (CBHI) scheme
in rural parts of the country. Based on a fixed effects analysis of household panel data, this paper assesses the
impact of the scheme on utilization of modern healthcare and the cost of accessing healthcare. It adds to the
relatively small body of work that provides a rigorous evaluation of CBHI schemes. We find that in the case of
public health facilities, enrolment leads to a 30'41% increase in utilization of outpatient care, a 45'64% increase
in the frequency of visits and at least a 56% decline in the cost per visit. The impact on utilization and costs
combined with a high uptake rate of almost 50% within two years of scheme establishment underlines the
relative success of the Ethiopian scheme. While there are several reasons for this success, a comparative analysis
of the design and execution of the Ethiopia CBHI with the existing body of work yields two distinct features.
First, the Ethiopian scheme is embedded within existing government administrative structures and to signal
government commitment, scheme performance and uptake is used as a yardstick to measure the success of the
administration. Second, an existing social protection scheme was used to spread information, raise scheme
awareness and encourage uptake of health insurance. The alignment of the interests of administrators with
scheme performance and interlinking of social protection schemes are innovative design features that are worth
considering as developing countries strive to enhance access to health care through voluntary insurance
schemes. - We gratefully acknowledge financial support from the Netherlands
Organisation for Scientific Research (NWO-WOTRO) grant number
W07.45.103.00, the University of Goettingen and the Ethiopian
Economics Association. |
Subject(s)
Community based health insurance; Healthcare utilization; Out-of-pocket expenditure; Ethiopia |
Language
en_AU |
Publisher
Elsevier |
Type of publication
Journal article |
Format
application/pdf |
Source
Social Science and Medicine |
Rights
© 2018 Elsevier Ltd. |
Identifier
0277-9536; 10.1016/j.socscimed.2018.11.003 |
Repository
Canberra - Australian National University
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Added to C-A: 2022-05-09;09:37:17 |
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