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Elfaki NS, Abdelgyoum HA, Elhelali A. Factors influencing health-seeking behavior among Sudanese immigrants in Saudi Arabia. BMC Public Health 2024; 24:1666. [PMID: 38909181 PMCID: PMC11193163 DOI: 10.1186/s12889-024-19122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Health-seeking behavior (HSB) involves any action or inaction taken by individuals who perceive themselves to have a health problem or illness aimed at finding appropriate medical treatments. Studies suggest a positive relationship between the availability and quality of health services and their utilization. This study aimed to identify the factors influencing health-seeking behavior among Sudanese immigrants in Saudi Arabia, to improve healthcare access and health outcomes. METHOD A cross-sectional study was conducted targeting Sudanese residents of the Kingdom of Saudi Arabia (KSA). Participants were recruited using convenient sampling. A self-administered questionnaire was distributed electronically. A total of 494 participants were recruited for the study. RESULTS This study showed that the majority of the participants (66.6%) visited a primary healthcare center when faced with a medical problem. However, the prevalence of self-medication in the past three months was 45.7%. Significant factors influencing health-seeking behavior included age (OR [95% CI]: 1.032 [1.000-1.066]) and lack of health insurance (OR = 1.01, 95% CI [1.00-1.02], p = 0.019). CONCLUSIONS This study emphasizes the importance of understanding healthcare-seeking behavior among immigrant groups, particularly Sudanese immigrants in Saudi Arabia. It highlights the significance of insurance as a determinant of healthcare-seeking behavior and calls for reforming current policies to reduce disparities in accessing healthcare services.
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Affiliation(s)
- Noor S Elfaki
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Ala Elhelali
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD, USA
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Fetene SM, Mengistu MY, Aschalew AY. Effectiveness and impact of community-based health insurance on health service utilization in northwest Ethiopia: a quasi-experimental evaluation. Front Public Health 2023; 11:1078462. [PMID: 38026288 PMCID: PMC10679351 DOI: 10.3389/fpubh.2023.1078462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Addressing the health challenges of lower socioeconomic groups in Ethiopia is still a huge problem. In that regard, the government piloted the community-based health insurance (CBHI) in 2011 in a few districts and subsequently scaled up. However, the effectiveness of the program on the utilization of health services and its impact was not well explored. Thus, we aimed to evaluate the effectiveness of CBHI toward health services' utilization and its impact in northwest Ethiopia. Methods A quasi-experimental matched comparison group evaluation design with sequential explanatory mixed methods was employed. To evaluate the CBHI program, the effectiveness and impact dimensions from the Organization for Economic Cooperation and Development framework were used. A multistage sampling technique was used to select a total of 332 households enrolled in the CBHI program; 341 comparison households who did not enroll in the program were also randomly selected. A structured interviewer-administrated questionnaire was used to evaluate the effectiveness and impact of CBHI on health service utilization. The Propensity score matching model was employed for the estimation of the effect of the CBHI program on health service utilization. Challenges for program achievement toward health service utilization were explained through qualitative data and these were then analyzed thematically. Results The evaluation showed 1.3 visits per capita per year of health service utilization among CBHI members. Households enrolled in CBHI increased health service utilization by 6.9 percentage points (ATT = 0.069; 95% CI: 0.034, 0.114). There was an improvement in health service utilization after the introduction of CBHI, however, there are challenges: (i) shortage of human resources, (ii) out-of-stock of drugs and medical supplies, and (iii) long waiting times for service and reimbursement claims. These issues limit the success of the program toward health service utilization. Conclusion The CBHI program contributed to health service utilization improvement among CBHI members. However, the utilization rate of health services among CBHI members is still less than the target stated for the program and also the WHO recommendation. Therefore, the findings of this evaluation can be used by program implementers, policy makers, and other stakeholders to overcome the identified challenges and to increase the success of the program.
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Affiliation(s)
- Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Eze P, Ilechukwu S, Lawani LO. Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0287600. [PMID: 37368882 DOI: 10.1371/journal.pone.0287600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). METHODS We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane's Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796. RESULTS We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04-2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22-2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61-3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74-3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92-0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54-0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54-0.96). The main limitations of our study are the limited data available for meta-analyses and high heterogeneity persisted in subgroup and sensitivity analyses. CONCLUSIONS Our study shows that CBHI generally improves healthcare utilization but inconsistently delivers financial protection from health expenditure shocks. With pragmatic context-specific policies and operational modifications, CBHI could be a promising mechanism for achieving universal health coverage (UHC) in LMICs.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Penn State University, University Park, PA, United States of America
| | - Stanley Ilechukwu
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health Projects, South Saharan Social Development Organization (SSDO), Independence Layout, Enugu, Nigeria
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Alemayehu YK, Dessie E, Medhin G, Birhanu N, Hotchkiss DR, Teklu AM, Kiros M. The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia. BMC Health Serv Res 2023; 23:67. [PMID: 36683041 PMCID: PMC9869550 DOI: 10.1186/s12913-022-09019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023] Open
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.
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Affiliation(s)
| | - Ermias Dessie
- World Health Organization – Ethiopia, Addis Ababa, Ethiopia
| | | | - Negalign Birhanu
- grid.411903.e0000 0001 2034 9160Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - David R. Hotchkiss
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | | | - Mizan Kiros
- grid.414835.f0000 0004 0439 6364Ministry of Health, Addis Ababa, Ethiopia
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Onyemaechi S, Ezenwaka U. Influence of sub-national social health insurance scheme on enrollees' health seeking behaviour in Anambra state, Nigeria: a pre and post study. BMC Public Health 2022; 22:1171. [PMID: 35690808 PMCID: PMC9188698 DOI: 10.1186/s12889-022-13606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Appropriate health-seeking behaviour (HSB) is crucial for improving health outcomes and achieving universal health coverage (UHC). Accessing healthcare through the state social health insurance scheme (SSHIS) could lead to improved HSB. The study explores the influence of access to healthcare through health insurance on the HSB of the enrollees of the SSHIS in southeast, Nigeria. Methods A descriptive cross-sectional study undertaken in twelve health facilities in Anambra state using quantitative and qualitative research methods. Data were collected through a facility-based survey (n = 447) and sex-disaggregated focus group discussions (n = 12) of health insurance enrollees. Univariate and bivariate analyses were performed for quantitative data, while qualitative data were analyzed using a manual content approach. Result The findings revealed a positive change in enrollee’s HSB post-health insurance enrollment. Majority (83%) of the respondents reported that they immediately take action when ill post-health insurance enrollment as against 34% (pre-health insurance) resulting in a 49% increase, with a statistically significant difference (p < 0.02). There was a statistically significant association between positive HSB and marital status (p < 0.04); educational level (p < 0.00); occupation (p < 0.03) and ownership of health facility (p < 0.00). There was an increase in the percentage of enrollees who use the hospital as their first choice of provider during an illness episode post-health insurance enrollment. This increased from 37.4% to 90.2% (post-health insurance enrollment), representing a 52.8% increase, which is statistically significant (p < 0.03), in seeking care in hospitals. Similarly, the percentage (46%) of enrollees using patent medicine vendors (PMVs) as their first choice of provider when ill prior to enrollment in health insurance decreased to 8.1% post-health insurance enrollment, representing a 38% decline with a statistically significant (p < 0.00) drop in PMV patronage. Reasons for positive HSB include low cost of services and availability of quality care such as quality drugs, presence of doctors, and other skilled health workers by the health insurance facilities. Conclusion Health insurance has been established as an effective strategy for improving appropriate HSB. Hence, increasing coverage of health insurance among the uninsured is crucial in improving access to quality and affordable health care towards achieving UHC, particularly in developing countries.
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Affiliation(s)
- Simeon Onyemaechi
- Anambra State Health Insurance Agency (ASHIA), Awka, Anambra State, Nigeria
| | - Uchenna Ezenwaka
- Department of Health Administration and Management, Faculty of Health Science and Technology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria. .,Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
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Rouyard T, Mano Y, Daff BM, Diouf S, Fall Dia K, Duval L, Thuilliez J, Nakamura R. Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal. Health Policy Plan 2022; 37:858-871. [PMID: 35413098 PMCID: PMC9347027 DOI: 10.1093/heapol/czac033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Community-based health insurance (CBHI) has been implemented in many low and middle-income countries to increase financial risk protection in populations without access to formal health insurance. While the design of such social programs is fundamental to ensuring equitable access to care, little is known about the operational and structural factors influencing enrolment in CBHI schemes. In this study, we took advantage of newly established data monitoring requirements in Senegal to explore the association between the operational capacity and structure of CBHI schemes-also termed 'mutual health organisations' (MHO) in francophone countries-and their enrolment levels. The dataset comprised 12 waves of quarterly data over 2017-2019 and covered all 676 MHOs registered in the country. Primary analyses were conducted using dynamic panel data regression analysis. We found that higher operational capacity significantly predicted higher performance: enrolment was positively associated with the presence of a salaried manager at the MHO level (12% more total enrollees, 23% more poor members) and with stronger cooperation between MHOs and local health posts (for each additional contract signed, total enrollees and poor members increased by 7% and 5%, respectively). However, higher operational capacity was only modestly associated with higher sustainability proxied by the proportion of enrollees up to date with premium payment. We also found that structural factors were influential, with MHOs located within a health facility enrolling fewer poor members (-16%). Sensitivity analyses showed that these associations were robust. Our findings suggest that policies aimed at professionalising and reinforcing the operational capacity of MHOs could accelerate the expansion of CBHI coverage, including in the most impoverished populations. However, they also suggest that increasing operational capacity alone may be insufficient to make CBHI schemes sustainable over time.
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Affiliation(s)
- Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo, Japan
| | - Yukichi Mano
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
| | - Bocar Mamadou Daff
- National Agency for Universal Health Financial Protection, Dakar, Senegal
| | - Serigne Diouf
- National Agency for Universal Health Financial Protection, Dakar, Senegal
| | | | - Laetitia Duval
- Centre d'Économie de la Sorbonne, UMR 8174, Centre National de la Recherche Scientifique-Université Paris 1 Panthéon-Sorbonne, Paris, France
| | - Josselin Thuilliez
- Centre d'Économie de la Sorbonne, UMR 8174, Centre National de la Recherche Scientifique-Université Paris 1 Panthéon-Sorbonne, Paris, France
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi University, Tokyo, Japan
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Factors associated with catastrophic health care expenditure in South Wollo province, Ethiopia: A cross‐sectional study. Int J Health Plann Manage 2022; 37:1694-1707. [DOI: 10.1002/hpm.3432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/07/2022] Open
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Rabbani A, Mehareen J, Chowdhury IA, Sarker M. Mandatory employer-sponsored health financing scheme for semiformal workers in Bangladesh: An experimental assessment. Soc Sci Med 2021; 292:114590. [PMID: 34871854 DOI: 10.1016/j.socscimed.2021.114590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/07/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022]
Abstract
In this study, we present findings from an experimental evaluation of a mandatory employer-sponsored health insurance scheme in Bangladesh. We randomly introduced the scheme to female artisans to understand the impacts on healthcare utilisation, expenditure and subjective well-being using both survey and administrative data. Our findings suggest that the scheme broke even; however, it covered only six percent of the overall health expenditure and 16 percent of the hospitalisation costs. We find higher inpatient care utilisation, particularly among women, and in favour of empanelled hospitals causally associated with the intervention, consistent with the design of the scheme. We do not find significant healthcare savings or improvement in subjective well-being, consistent with low coverage. The findings suggest the scheme to be financially sustainable and it changes the healthcare seeking behaviours as the scheme incentivises. However, meaningful savings and protection against catastrophic health expenditures will require a higher level of coverage.
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Affiliation(s)
- Atonu Rabbani
- Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh; BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka,1213, Bangladesh.
| | - Jeenat Mehareen
- Department of Economics, East West University, Dhaka, Bangladesh
| | - Imran Ahmed Chowdhury
- Health, Nutrition and Population Programme, BRAC, 75 Mohakhali, Dhaka, 1212, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka,1213, Bangladesh; Global Health Institute, ImNeuenheimer Feld 130.3, MarsiliusArkaden - 6. Stock, 69120, Heidelberg, Germany
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Ahmed S, Hasan MZ, Ali N, Ahmed MW, Haq E, Shabnam S, Chowdhury M, Gahan B, Bousquet C, Khan JAM, Islam Z. Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach. PLoS One 2021; 16:e0256067. [PMID: 34723992 PMCID: PMC8559931 DOI: 10.1371/journal.pone.0256067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes. Methods HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care. Results Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme. Conclusion HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider’s costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.
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Affiliation(s)
- Sayem Ahmed
- Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
- * E-mail:
| | - Md. Zahid Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Bangladesh Institute of Development Studies (BIDS), Agargaon, Dhaka, Bangladesh
| | - Mohammad Wahid Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | | | - Jahangir A. M. Khan
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
- Health Economics and Policy Unit, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Nannini M, Biggeri M, Putoto G. Financial protection and coping strategies in rural Uganda: an impact evaluation of community-based zero-interest healthcare loans. Health Policy Plan 2021; 36:1090-1102. [PMID: 34159376 DOI: 10.1093/heapol/czab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
In low- and middle-income countries, catastrophic health expenditures and economic hardship constitute a common risk for households' welfare. Community health financing (CHF) represents a viable option to improve financial protection, but robust impact evaluations are needed to advance the debate concerning universal health coverage in informal settings. This study aims at assessing the impact of a CHF pilot programme and, specifically, of the initial phase involving zero-interest loans on health expenditures and coping strategies in a rural district of Uganda. The analysis relies on a panel household survey performed before and after the intervention and complemented by qualitative data obtained from structured focus group discussions. Exploiting an instrumental variable approach, we measured the causal effect of the intervention, and the main findings were then integrated with qualitative evidence on the heterogeneity of the programme's impact across different household categories. We found that the intervention of zero-interest healthcare loans is effective in improving financial protection and longer-term welfare. Community perceptions suggested that the population excluded from the scheme is disadvantaged when facing unpredictable health costs. Among the enrolled members, the poorest seem to receive a greater benefit from the intervention. Overall, our study provides support for the positive role of community-based mechanisms to progress towards universal coverage and offers policy-relevant insights to timely design comprehensive health financing reforms.
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Affiliation(s)
- Maria Nannini
- Department of Economics and Management, University of Florence, Via delle Pandette 9, 50127, Florence, Italy
| | - Mario Biggeri
- Department of Economics and Management, University of Florence, Via delle Pandette 9, 50127, Florence, Italy
| | - Giovanni Putoto
- Doctors with Africa CUAMM, Via San Francesco 126, 35121, Padua, Italy
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Khan JAM, Ahmed S, Sultana M, Sarker AR, Chakrovorty S, Rahman MH, Islam Z, Rehnberg C, Niessen LW. The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh. Int Health 2020; 12:287-298. [PMID: 31782795 PMCID: PMC7322207 DOI: 10.1093/inthealth/ihz083] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh. METHODS A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates. RESULTS The OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones. CONCLUSIONS The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.
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Affiliation(s)
- Jahangir A M Khan
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Sayem Ahmed
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Marufa Sultana
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Deakin Health Economics, School of Health and Social Development, Deakin University, 221 Burwood Highway Burwood VIC 3125 Melbourne, Australia
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Population Studies Division, Bangladesh Institute of Development Studies (BIDS), E-17, Shahid Shahabuddin Shorok, Agargaon, Dhaka 1207, Bangladesh
| | - Sanchita Chakrovorty
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Department of Agricultural Economics, Purdue University, Room # 631, Krannert Building, 403 West State Street, West Lafayette, Indiana 47906, USA
| | - Mohammad Hafizur Rahman
- Health Economics Unit, Ministry of Health and Family Welfare, 14/2 Topkhana Road (3rd–4th Floor), Dhaka 1000, Bangladesh
| | - Ziaul Islam
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Clas Rehnberg
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Louis W Niessen
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
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Al-Hanawi MK, Mwale ML, Kamninga TM. The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia. Risk Manag Healthc Policy 2020; 13:595-607. [PMID: 32607027 PMCID: PMC7308143 DOI: 10.2147/rmhp.s257381] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Saudi Arabia's healthcare sector is growing at a hasty stride; nevertheless, the quality of healthcare consumption remains challenged by the growing caseload in free public health facilities. Insurance could ease this pressure by moving some healthcare demand to private facilities conditional on its ability to enact health-seeking behaviour. These potential effects remain under-investigated. Therefore, the aim of this study was to investigate whether health insurance nudges health-seeking behaviour using data from Saudi Arabia. Materials and Methods The study used nationally representative secondary data, obtained from the Family Health Survey, conducted in 2018, in Saudi Arabia. Health-seeking behaviour was measured by individual attendance of medical check-up. To account for endogeneity due to non-random selection of individuals into insurance, the analysis employed the inverse propensity weighting and the instrumental variables methods. Results The results revealed that health insurance leads to increased chances of going for medical check-up. The effects are higher amongst non-Saudi nationals relative to citizens. Furthermore, people who purchase personal health insurance schemes are more likely to go for checks-ups, followed by individuals provided by the private sector and government sector. Finally, the study found that insurance positively nudges hypertension, diabetes, and cholesterol specific medical check-ups. Conclusion The findings indicated the need for health policy to increase access to health insurance in Saudi Arabia. A notable policy response is the introduction of national health insurance coverage, which has already proven in other countries as an effective measure to attain universal access to improved health. Nevertheless, results from this study highlighted variations in demand for health seeking based on type of insurance with highest returns in personal insurance. Policy should leverage on this behaviour response by introducing insurance packages that share premiums with citizens to incentivise utilisation. The results can also be used to design policy responses to demand for insurance, in the entire Arabian Gulf region, since these countries have similar health financing mechanism with Saudi Arabia.
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Affiliation(s)
- Mohammed Khaled Al-Hanawi
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Martin Limbikani Mwale
- Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tony Mwenda Kamninga
- Department of Economics, Faculty of Social and Health Sciences, Millennium University, Blantyre, Malawi
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Ahmed S, Sarker AR, Sultana M, Roth F, Mahumud RA, Kamruzzaman M, Hasan MZ, Mirelman AJ, Islam Z, Niessen LW, Rehnberg C, Khan AA, Gyr N, Khan JAM. Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case-control study in Bangladesh. BMJ Open 2020; 10:e030298. [PMID: 32132134 PMCID: PMC7059493 DOI: 10.1136/bmjopen-2019-030298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 12/02/2019] [Accepted: 12/17/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healthcare utilisation of medically trained providers and reduction of out-of-pocket (OOP) expenditure among ready-made garment (RMG) workers. DESIGN We used a case-control study design with cross-sectional preintervention and postintervention surveys. SETTINGS The study was conducted among workers of seven purposively selected RMG factories in Shafipur, Gazipur in Bangladesh. PARTICIPANTS In total, 1924 RMG workers (480 from the insured and 482 from the uninsured, in each period) were surveyed from insured and uninsured RMG factories, respectively, in the preintervention (October 2013) and postintervention (April 2015) period. INTERVENTIONS We tested the effect of a pilot ESHI scheme which was implemented for 1 year. OUTCOME MEASURES The outcome measures were utilisation of medically trained providers and reduction of OOP expenditure among RMG workers. We estimated difference-in-difference (DiD) and applied two-part regression model to measure the association between healthcare utilisation, OOP payments and ESHI scheme membership while controlling for the socioeconomic characteristics of workers. RESULTS The ESHI scheme increased healthcare utilisation of medically trained providers by 26.1% (DiD=26.1; p<0.01) among insured workers compared with uninsured workers. While accounting for covariates, the effect on utilisation significantly reduced to 18.4% (p<0.05). The DiD estimate showed that OOP expenditure among insured workers decreased by -3700 Bangladeshi taka and -1100 Bangladeshi taka compared with uninsured workers when using healthcare services from medically trained providers or all provider respectively, although not significant. The multiple two-part models also reported similar results. CONCLUSION The ESHI scheme significantly increased utilisation of medically trained providers among RMG workers. However, it has no significant effect on OOP expenditure. It can be recommended that an educational intervention be provided to RMG workers to improve their healthcare-seeking behaviours and increase their utilisation of ESHI-designated healthcare providers while keeping OOP payments low.
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Affiliation(s)
- Sayem Ahmed
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health Economics and Policy, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde, Glasgow, UK
- Health Economics and Financing Research, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Marufa Sultana
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Felix Roth
- Swiss Micro Insurance Consultancy Group (SMCG), Basel, Switzerland
| | - Rashidul Alam Mahumud
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | - Md Zahid Hasan
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ziaul Islam
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Louis W Niessen
- Liverpool School of Tropical Medicine, Liverpool, UK
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Clas Rehnberg
- Health Economics and Policy, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Ak Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Basel, Switzerland
| | - Jahangir A M Khan
- Health Economics and Policy, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Liverpool School of Tropical Medicine, Liverpool, UK
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De Allegri M, Lohmann J, Souares A, Hillebrecht M, Hamadou S, Hien H, Haidara O, Robyn PJ. Responding to policy makers' evaluation needs: combining experimental and quasi-experimental approaches to estimate the impact of performance based financing in Burkina Faso. BMC Health Serv Res 2019; 19:733. [PMID: 31640694 PMCID: PMC6805435 DOI: 10.1186/s12913-019-4558-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The last two decades have seen a growing recognition of the need to expand the impact evaluation toolbox from an exclusive focus on randomized controlled trials to including quasi-experimental approaches. This appears to be particularly relevant when evaluation complex health interventions embedded in real-life settings often characterized by multiple research interests, limited researcher control, concurrently implemented policies and interventions, and other internal validity-threatening circumstances. To date, however, most studies described in the literature have employed either an exclusive experimental or an exclusive quasi-experimental approach. METHODS This paper presents the case of a study design exploiting the respective advantages of both approaches by combining experimental and quasi-experimental elements to evaluate the impact of a Performance-Based Financing (PBF) intervention in Burkina Faso. Specifically, the study employed a quasi-experimental design (pretest-posttest with comparison) with a nested experimental component (randomized controlled trial). A difference-in-differences approach was used as the main analytical strategy. DISCUSSION We aim to illustrate a way to reconcile scientific and pragmatic concerns to generate policy-relevant evidence on the intervention's impact, which is methodologically rigorous in its identification strategy but also considerate of the context within which the intervention took place. In particular, we highlight how we formulated our research questions, ultimately leading our design choices, on the basis of the knowledge needs expressed by the policy and implementing stakeholders. We discuss methodological weaknesses of the design arising from contextual constraints and the accommodation of various interests, and how we worked ex-post to address them to the best extent possible to ensure maximal accuracy and credibility of our findings. We hope that our case may be inspirational for other researchers wishing to undertake research in settings where field circumstances do not appear to be ideal for an impact evaluation. TRIAL REGISTRATION Registered with RIDIE (RIDIE-STUDY-ID- 54412a964bce8 ) on 10/17/2014.
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Affiliation(s)
- Manuela De Allegri
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Julia Lohmann
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Aurélia Souares
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Michael Hillebrecht
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Saidou Hamadou
- The World Bank; Nouvelle Route Bastos B. P 1128, Yaoundé, Cameroon
| | - Hervé Hien
- Centre MURAZ, 2054 Avenue Mamadou KONATE, 01 B.P. 390, Bobo-Dioulasso, 01 Burkina Faso
| | - Ousmane Haidara
- The World Bank; Health, Nutrition, Population Global Practice, 1818 H Street, NW, Washington, DC 20433 USA
| | - Paul Jacob Robyn
- The World Bank; Health, Nutrition, Population Global Practice, 1818 H Street, NW, Washington, DC 20433 USA
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Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0219731. [PMID: 31461458 PMCID: PMC6713352 DOI: 10.1371/journal.pone.0219731] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. METHODS We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. FINDINGS 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.
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Affiliation(s)
- Darius Erlangga
- Department of Health Sciences, University of York, York, England, United Kingdom
| | - Marc Suhrcke
- Centre of Health Economics, University of York, York, England, United Kingdom
- Luxembourg Institute of Socio-economic Research (LISER), Luxembourg
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England, United Kingdom
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karen Bloor
- Department of Health Sciences, University of York, York, England, United Kingdom
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Mekonen AM, Gebregziabher MG, Teferra AS. The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study. PLoS One 2018; 13:e0205972. [PMID: 30335838 PMCID: PMC6193712 DOI: 10.1371/journal.pone.0205972] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 10/04/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Moving towards the goal of universal health coverage requires strengthening service delivery and overcoming significant financial barriers. The Government of Ethiopia is rolling out community based health insurance to protect the rural community from high out of pocket health expenditure and improve health service utilization. We investigated the effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia. METHODS A community based cross sectional study was conducted. A Multi stage sampling technique was used to get a total of 454 (224 insured and 230 uninsured) households. The data were entered using EPI info version 7 and analyzed using SPSS version 20 and STATA version 13 for binary logistic regression analysis and propensity score matching analysis respectively. Wealth status of the households was computed by Principal Component Analysis (PCA). A multivariable logistic regression analysis was done to identify the predictors of catastrophic health expenditure. Propensity score matching analysis was used to determine the effect of community based health insurance on catastrophic health expenditure. The average treatment effect on the treated (ATT) was calculated to compare the means of outcomes across insured and uninsured households. RESULTS A total of 454 household heads were included in the study, making a response rate of 91.2%.The total level of catastrophic health expenditure was found to be 20%. Among the households with catastrophic health expenditure, 4.41% were insured, whereas the remaining 15.64% were noninsured. Insured households (AOR = 0.19, 95% CI: 0.11-0.34), rich households (AOR = 1.98; 95% CI: 1.07-3.66), having member with chronic illness (AOR = 2.13, 95% CI: 1.01-4.51) and having member encountered any illness during the past 3 months (AOR = 2.44, 95% CI: 1.35-4.40) were statistically associated with catastrophic health expenditure. Community based health insurance contributed to 23.2% (t = -5.94) (95% CI: -0.31_-0.15) reduction of catastrophic health expenditure. CONCLUSION The overall level of catastrophic health expenditure was high among noninsured households. Community based health insurance has significant financial protection from catastrophic health expenditure in northeast Ethiopia. Thus, the government need to scale up community based health insurance to protect the noninsured households from catastrophic health expenditure.
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Affiliation(s)
- Asnakew Molla Mekonen
- Department of Health Service Management and Health Economics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Alemayehu Shimeka Teferra
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Dror DM, Chakraborty A, Majumdar A, Panda P, Koren R. Impact of community-based health insurance in rural India on self-medication & financial protection of the insured. Indian J Med Res 2017; 143:809-820. [PMID: 27748307 PMCID: PMC5094122 DOI: 10.4103/0971-5916.192075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar s0 tates of India on insured households' self-medication and financial position. METHODS Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was "staggered implementation" cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results. RESULTS Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH's location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations. INTERPRETATION & CONCLUSIONS The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.
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Affiliation(s)
- David M Dror
- Micro Insurance Academy, New Delhi, India and Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Arpita Chakraborty
- Micro Insurance Academy, New Delhi, India and Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands; Public Health Foundation of India, Gurgaon, India,
| | - Atanu Majumdar
- Micro Insurance Academy, New Delhi, India and Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Pradeep Panda
- Micro Insurance Academy, New Delhi, India and Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Ruth Koren
- Tel Aviv University, Rabin Medical Center, Petah Tikva, Israel
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Panda P, Chakraborty A, Raza W, Bedi AS. Renewing membership in three community-based health insurance schemes in rural India. Health Policy Plan 2016; 31:1433-1444. [DOI: 10.1093/heapol/czw090] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 11/13/2022] Open
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O'Donnell O, Jones AM. Symposium: Efforts to Extend Effective Coverage in Asia. HEALTH ECONOMICS 2016; 25:647-649. [PMID: 27061754 DOI: 10.1002/hec.3344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Owen O'Donnell
- Erasmus University Rotterdam, Rotterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
- University of Macedonia, Thessaloniki, Greece
| | - Andrew M Jones
- University of York, York, UK
- Monash University, Melbourne, VIC, Australia
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