Community-based health insurance and healthcare service utilisation, North-West, Ethiopia: a comparative, cross-sectional study

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Abstract

Objectives

The objective of this study was to compare differences in healthcare utilisation between community-based health insurance member households and non-member households and to identify factors for community-based health insurance enrolment in South Achefer District.

Design

Comparative, cross-sectional study.

Settings

Community-based.

Participants

A total of 652 selected households (326 insured and 326 uninsured households) participated in the study.

Methods

A two-sample t-test (for proportions) and χ ² (for categorical data) were computed.

Main outcome measure

Utilisation of healthcare.

Results

There was a significant difference in the rate of healthcare utilisation between insured (50.5%) and uninsured (29.3%) households (χ ²=27.864, p<0.001). Significant variations of enrolment status in community-based health insurance were observed in the following variables: educational status, family size, occupation, marital status, travel time to the nearest health institution, perceived quality of care, first choice of place for treatment during illness and expected healthcare cost of a recent treatment.

Conclusions

Utilisation of health services among insured households with community-based health insurance was higher. Educational status, family size, occupation, marital status, travel time to the nearest health institution, perceived quality of care, first choice of place for treatment during illness and expected healthcare cost of a recent treatment should be emphasised to enhance community health insurance enrolment.

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Most cited references 16

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Coping with out-of-pocket health payments: empirical evidence from 15 African countries

Adam A Leive, Ke Xu (2008)

OBJECTIVE: To explore factors associated with household coping behaviours in the face of health expenditures in 15 African countries and provide evidence for policy-makers in designing financial health protection mechanisms. METHODS: A series of logit regressions were performed to explore factors correlating with a greater likelihood of selling assets, borrowing or both to finance health care. The average partial effects for different levels of spending on inpatient care were derived by computing the partial effects for each observation and taking the average across the sample. Data used in the analysis were from the 2002-2003 World Health Survey, which asked how households had financed out-of-pocket payments over the previous year. Households selling assets or borrowing money were compared to those that financed health care from income or savings. Those that used insurance were excluded. For the analysis, a value of 1 was assigned to selling assets or borrowing money and a value of 0 to other coping mechanisms. FINDINGS: Coping through borrowing and selling assets ranged from 23% of households in Zambia to 68% in Burkina Faso. In general, the highest income groups were less likely to borrow and sell assets, but coping mechanisms did not differ strongly among lower income quintiles. Households with higher inpatient expenses were significantly more likely to borrow and deplete assets compared to those financing outpatient care or routine medical expenses, except in Burkina Faso, Namibia and Swaziland. In eight countries, the coefficient on the highest quintile of inpatient spending had a P-value below 0.01. CONCLUSION: In most African countries, the health financing system is too weak to protect households from health shocks. Borrowing and selling assets to finance health care are common. Formal prepayment schemes could benefit many households, and an overall social protection network could help to mitigate the long-term effects of ill health on household well-being and support poverty reduction.

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Something old or something new? Social health insurance in Ghana

Sophie Witter, Bertha Garshong (2009)

Background There is considerable interest at present in exploring the potential of social health insurance to increase access to and affordability of health care in Africa. A number of countries are currently experimenting with different approaches. Ghana's National Health Insurance Scheme (NHIS) was passed into law in 2003 but fully implemented from late 2005. It has already reached impressive coverage levels. This article aims to provide a preliminary assessment of the NHIS to date. This can inform the development of the NHIS itself but also other innovations in the region. Methods This article is based on analysis of routine data, on secondary literature and on key informant interviews conducted by the authors with stakeholders at national, regional and district levels over the period of 2005 to 2009. Results In relation to its financing sources, the NHIS is heavily reliant on tax funding for 70–75% of its revenue. This has permitted quick expansion of coverage, partly through the inclusion of large exempted population groups. Card holders increased from 7% of the population in 2005 to 45% in 2008. However, only around a third of these are contributing to the scheme financially. This presents a sustainability problem, in that revenue is de-coupled from the growing membership. In addition, the NHIS offers a broad benefits package, with no co-payments and limited gate-keeping, and also faces cost escalation related to its new payment system and the growing utilisation of members. These features contributed to a growth in distressed schemes and failure to pay outstanding facility claims in 2008. The NHIS has had a considerable impact on the health system as a whole, taking on a growing role in funding curative care. In 2009, it is expected to contribute 41% of the overall resource envelope. However there is evidence that this funding is not additional but has been switched from other funding channels. There are some equity concerns about this, as the new funding source (a VAT-based tax) may be more regressive. In addition, membership of the NHIS at present has a pro-rich bias, and a pro-urban bias in relation to renewals. Only a very small proportion is registered as indigent, and there is some evidence of 'squeezing out' of non-members from health care utilisation. Finally, considerable challenges remain in relation to strengthening the purchasing role of the NHIS, and also settling debates about its structure and accountability. Conclusion Some trade-offs will be necessary between the existing wide benefits package of the NHIS and the laudable desire to reach universal coverage. The overall resource envelope for health is likely to be stable rather than increasing over the medium-term. In the longer term, the investment costs in the NHIS will only be justified if it is able to increase the cost-effectiveness of purchasing and the responsiveness of the system as a whole.

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Rural food security, subsistence agriculture, and seasonality

Kibrom T. Sibhatu, Matin Qaim (2017)

Many of the world’s food-insecure and undernourished people are smallholder farmers in developing countries. This is especially true in Africa. There is an urgent need to make smallholder agriculture and food systems more nutrition-sensitive. African farm households are known to consume a sizeable part of what they produce at home. Less is known about how much subsistence agriculture actually contributes to household diets, and how this contribution changes seasonally. We use representative data from rural Ethiopia covering every month of one full year to address this knowledge gap. On average, subsistence production accounts for 58% of rural households’ calorie consumption, that is, 42% of the calories consumed are from purchased foods. Some seasonal variation occurs. During the lean season, purchased foods account for more than half of all calories consumed. But even during the main harvest and post-harvest season, purchased foods contribute more than one-third to total calorie consumption. Markets are even more important for dietary quality. During all seasons, purchased foods play a much larger role for dietary diversity than subsistence production. These findings suggest that strengthening rural markets needs to be a key element in strategies to improve food security and dietary quality in the African small-farm sector.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2018

Publication date (Electronic): 8 August 2018

Volume: 8

Issue: 8

Electronic Location Identifier: e019613

Affiliations

[1 ] departmentSchool of Public Health, College of Medicine and Health Sciences , Bahir Dar University , Bahir Dar, Ethiopia

[2 ] departmentCurative and Rehabilitative Core Process , Amhara Regional Health Bureau , Bahir Dar, Ethiopia

Author notes

[Correspondence to ] Mr. Desta Debalkie Atnafu; destad2a@ 123456gmail.com

Author information

Desta Debalkie Atnafu http://orcid.org/0000-000296604225

Yihun Mulugeta Alemu http://orcid.org/0000-0003-3145-3494

Article

Publisher ID: bmjopen-2017-019613

DOI: 10.1136/bmjopen-2017-019613

PMC ID: 6089309

PubMed ID: 30093509

SO-VID: 6bf3b633-153d-4225-ab31-ccf03f6a8e18

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 13 September 2017

Date revision received : 11 June 2018

Date accepted : 03 July 2018

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ScienceOpen disciplines: Medicine

Keywords: health economics,health policy,human resource management

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ScienceOpen disciplines: Medicine

Keywords: health economics, health policy, human resource management

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Community-based health insurance and healthcare service utilisation, North-West, Ethiopia: a comparative, cross-sectional study

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Abstract

Objectives

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Climate Change and Human Health

Most cited references 16

Coping with out-of-pocket health payments: empirical evidence from 15 African countries

Something old or something new? Social health insurance in Ghana

Rural food security, subsistence agriculture, and seasonality

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