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The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia
BACKGROUND: Evidence on the effectiveness of community-based health insurance (CBHI) in low-income countries is inconclusive. This study assessed the impact of CBHI on health service utilization and financial risk protection in Ethiopia. METHODS: We conducted a comparative cross-sectional study nest...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9869550/ https://www.ncbi.nlm.nih.gov/pubmed/36683041 http://dx.doi.org/10.1186/s12913-022-09019-6 |
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author | Alemayehu, Yibeltal Kiflie Dessie, Ermias Medhin, Girmay Birhanu, Negalign Hotchkiss, David R. Teklu, Alula M. Kiros, Mizan |
author_facet | Alemayehu, Yibeltal Kiflie Dessie, Ermias Medhin, Girmay Birhanu, Negalign Hotchkiss, David R. Teklu, Alula M. Kiros, Mizan |
author_sort | Alemayehu, Yibeltal Kiflie |
collection | PubMed |
description | BACKGROUND: Evidence on the effectiveness of community-based health insurance (CBHI) in low-income countries is inconclusive. This study assessed the impact of CBHI on health service utilization and financial risk protection in Ethiopia. METHODS: We conducted a comparative cross-sectional study nested within a larger national household survey in 2020. Data was collected from three groups of households—CBHI member households (n = 1586), non-member households from CBHI implementing woredas (n = 1863), and non-member households from non-CBHI implementing woredas (n = 789). Indicators of health service utilization, out-of-pocket health spending, catastrophic health expenditure, and impoverishment due to health spending among CBHI members were compared with non-members from CBHI implementing woredas and households from non-CBHI implementing woredas. Propensity score matching (PSM) was used to account for possible selection bias. RESULTS: The annual number of OPD visits per capita among CBHI member households was 2.09, compared to 1.53 among non-member households from CBHI woredas and 1.75 among households from non-CBHI woredas. PSM estimates indicated that CBHI members had 0.36 (95% CI: 0.25, 0.44) and 0.17 (95% CI: -0.04, 0.19) more outpatient department (OPD) visits per capita per year than their matched non-member households from CBHI-implementing and non-CBHI implementing woredas, respectively. CBHI membership resulted in a 28–43% reduction in annual OOP payments as compared to non-member households. CBHI member households were significantly less likely to incur catastrophic health expenditures (measured as annual OOP payments of more than 10% of the household’s total expenditure) compared to non-members (p < 0.01). CONCLUSION: CBHI membership increases health service utilization and financial protection. CBHI proves to be an important strategy for promoting universal health coverage. Implementing CBHI in all woredas and increasing membership among households in woredas that are already implementing CBHI will further expand its benefits. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-09019-6. |
format | Online Article Text |
id | pubmed-9869550 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-98695502023-01-24 The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia Alemayehu, Yibeltal Kiflie Dessie, Ermias Medhin, Girmay Birhanu, Negalign Hotchkiss, David R. Teklu, Alula M. Kiros, Mizan BMC Health Serv Res Research BACKGROUND: Evidence on the effectiveness of community-based health insurance (CBHI) in low-income countries is inconclusive. This study assessed the impact of CBHI on health service utilization and financial risk protection in Ethiopia. METHODS: We conducted a comparative cross-sectional study nested within a larger national household survey in 2020. Data was collected from three groups of households—CBHI member households (n = 1586), non-member households from CBHI implementing woredas (n = 1863), and non-member households from non-CBHI implementing woredas (n = 789). Indicators of health service utilization, out-of-pocket health spending, catastrophic health expenditure, and impoverishment due to health spending among CBHI members were compared with non-members from CBHI implementing woredas and households from non-CBHI implementing woredas. Propensity score matching (PSM) was used to account for possible selection bias. RESULTS: The annual number of OPD visits per capita among CBHI member households was 2.09, compared to 1.53 among non-member households from CBHI woredas and 1.75 among households from non-CBHI woredas. PSM estimates indicated that CBHI members had 0.36 (95% CI: 0.25, 0.44) and 0.17 (95% CI: -0.04, 0.19) more outpatient department (OPD) visits per capita per year than their matched non-member households from CBHI-implementing and non-CBHI implementing woredas, respectively. CBHI membership resulted in a 28–43% reduction in annual OOP payments as compared to non-member households. CBHI member households were significantly less likely to incur catastrophic health expenditures (measured as annual OOP payments of more than 10% of the household’s total expenditure) compared to non-members (p < 0.01). CONCLUSION: CBHI membership increases health service utilization and financial protection. CBHI proves to be an important strategy for promoting universal health coverage. Implementing CBHI in all woredas and increasing membership among households in woredas that are already implementing CBHI will further expand its benefits. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-09019-6. BioMed Central 2023-01-23 /pmc/articles/PMC9869550/ /pubmed/36683041 http://dx.doi.org/10.1186/s12913-022-09019-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Alemayehu, Yibeltal Kiflie Dessie, Ermias Medhin, Girmay Birhanu, Negalign Hotchkiss, David R. Teklu, Alula M. Kiros, Mizan The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia |
title | The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia |
title_full | The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia |
title_fullStr | The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia |
title_full_unstemmed | The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia |
title_short | The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia |
title_sort | impact of community-based health insurance on health service utilization and financial risk protection in ethiopia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9869550/ https://www.ncbi.nlm.nih.gov/pubmed/36683041 http://dx.doi.org/10.1186/s12913-022-09019-6 |
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