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      The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia

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          Abstract

          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.

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          Community-based health insurance in low-income countries: a systematic review of the evidence.

          B Ekman (2004)
          Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.
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            Do Community-based Health Insurance Schemes Improve Poor People’s Access to Health Care? Evidence From Rural Senegal

            Johannes P. Jütting (2004)
            Article 0 comments Cited 79 times – based on 0 reviews     Review now
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              The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis

              Tesfalidet Tekelab, Catherine L. Chojenta, Roger Smith … (2019)
              Background Newborns are at greatest risk of dying at and shortly after the time of birth. Newborn mortality remains an urgent concern and is an important indicator of child health, development and well-being. Studies examining the effectiveness of antenatal care on maternal and newborn health outcomes have provided conflicting results. The aim of this review and meta-analysis was to determine the pooled effect of antenatal care on neonatal mortality in sub-Saharan Africa. Methods We searched PubMed, Medline, EMBASE, CINAHL and Google Scholar from September to November 2016 and then updated our search on April 13, 2019. Two independent reviewers extracted data from eligible studies. The quality of each included study was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies (RoBANS). The results were reported based on risk ratio (RR) with 95% confidence intervals (CI) using a random-effects model. Results Eight hundred and ninety eight studies were initially identified. During screening, 23 studies were found to be relevant for data extraction. Of these, only twelve studies fulfilled the inclusion criteria and were included in the analysis. In five of the twelve studies included in the analysis, antenatal care service utilization had a significant association with neonatal mortality. The pooled risk ratio by the random-effects model was 0.61 (95% CI: 0.43, 0.86) for neonates born to women who received at least one antenatal care visit by a skilled provider as compared to neonates born to women who did not receive antenatal care. Conclusion This review indicates that utilization of at least one antenatal care visit by a skilled provider during pregnancy reduces the risk of neonatal mortality by 39% in sub-Saharan African countries. Thus, in order to accelerate progress towards the reduction of newborn deaths, all pregnant women should receive antenatal care during pregnancy.
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                Author and article information

                Contributors
                Yibeltal Kiflie Alemayehu:
                ORCID: http://orcid.org/0000-0002-1781-0777
                yibeltal.k@merqconsultancy.org
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 23 January 2023
                Publication date PMC-release: 23 January 2023
                Publication date Collection: 2023
                Volume: 23
                Electronic Location Identifier: 67
                Affiliations
                [1 ]MERQ Consultancy PLC, Addis Ababa, Ethiopia
                [2 ]World Health Organization – Ethiopia, Addis Ababa, Ethiopia
                [3 ]GRID grid.411903.e, ISNI 0000 0001 2034 9160, Department of Health Policy and Management, Institute of Health, , Jimma University, ; Jimma, Ethiopia
                [4 ]GRID grid.265219.b, ISNI 0000 0001 2217 8588, School of Public Health and Tropical Medicine, , Tulane University, ; New Orleans, USA
                [5 ]GRID grid.414835.f, ISNI 0000 0004 0439 6364, Ministry of Health, ; Addis Ababa, Ethiopia
                Author information
                http://orcid.org/0000-0002-1781-0777
                Article
                Publisher ID: 9019
                DOI: 10.1186/s12913-022-09019-6
                PMC ID: 9869550
                PubMed ID: 36683041
                SO-VID: 0767896c-395a-4dcc-8ba6-25e92e7db537
                Copyright © © The Author(s) 2023
                License:

                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/. The Creative Commons Public Domain Dedication waiver ( http://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.

                History
                Date received : 5 April 2022
                Date accepted : 30 December 2022
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2023

                ScienceOpen disciplines: Health & Social care
                Keywords: community-based health insurance,health care utilization,health financing,financial risk protection,ethiopia
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: community-based health insurance, health care utilization, health financing, financial risk protection, ethiopia

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