Pooled coverage of community based health insurance scheme enrolment in Ethiopia: Systematic review and meta-analysis. (Preprint)

2021 ◽  
Author(s):  
Ahmed Tahir ◽  
Abdilahi Omer ◽  
Abdifatah Elmi
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Access To Health Care ◽  
Meta Analysis ◽  
Group Analysis ◽  
Policy Implications ◽  
Test Statistic ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Manual Search

BACKGROUND Community Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. OBJECTIVE The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications. METHODS The systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I2 test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model. RESULTS Among 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97(95%CI: 41.68, 69.77) in earlier (2016-2017) studies than recent 37.33(95%CI: 24.82, 50.77) studies (2018-2020). CONCLUSIONS The pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages. CLINICALTRIAL Registration: the protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762

scholarly journals What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0160479 ◽  
Author(s):  
David Mark Dror ◽  
S. A. Shahed Hossain ◽  
Atanu Majumdar ◽  
Tracey Lynn Pérez Koehlmoos ◽  
Denny John ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Meta Analysis ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Community Based Health Insurance ◽  
Low And Middle Income

scholarly journals The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care

2020 ◽  
Vol 17 (22) ◽  
pp. 8558
Author(s):  
Zemzem Shigute ◽  
Anagaw D. Mebratie ◽  
Robert Sparrow ◽  
Getnet Alemu ◽  
Arjun S. Bedi
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Insurance ◽  
Access To Health Care ◽  
Sub Saharan Africa ◽  
Community Based ◽  
Community Based Health Insurance ◽  
The Impact

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Africa.

scholarly journals Socioeconomic inequality in premiums for a community-based health insurance scheme in Rwanda

2020 ◽  
Author(s):  
Gowokani Chijere Chirwa ◽  
Marc Suhrcke ◽  
Rodrigo Moreno-Serra
Keyword(s):  
Gender Differences ◽  
Health Insurance ◽  
Socioeconomic Inequality ◽  
Decomposition Analysis ◽  
Health Financing ◽  
Policy Implications ◽  
Community Based ◽  
Flat Rate ◽  
Community Based Health Insurance ◽  
Quantile Regression Decomposition

Abstract Community-based health insurance (CBHI) has gained popularity in many low- and middle-income countries, partly as a policy response to calls for low-cost, pro-poor health financing solutions. In Africa, Rwanda has successfully implemented two types of CBHI systems since 2005, one of which with a flat rate premium (2005–10) and the other with a stratified premium (2011–present). Existing CBHI evaluations have, however, tended to ignore the potential distributional aspects of the household contributions made towards CBHI. In this paper, we investigate the pattern of socioeconomic inequality in CBHI household premium contributions in Rwanda within the implementation periods. We also assess gender differences in CBHI contributions. Using the 2010/11 and 2013/14 rounds of national survey data, we quantify the magnitude of inequality in CBHI payments, decompose the concentration index of inequality, calculate Kakwani indices and implement unconditional quantile regression decomposition to assess gender differences in CBHI expenditure. We find that the CBHI with stratified premiums is less regressive than CBHI with a flat rate premium system. Decomposition analysis indicates that income and CBHI stratification explain a large share of the inequality in CBHI payments. With respect to gender, female-headed households make lower contributions towards CBHI expenditure, compared with male-headed households. In terms of policy implications, the results suggest that there may be a need for increasing the premium bracket for the wealthier households, as well as for the provision of more subsidies to vulnerable households.

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