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Aiming for Universal Health Coverage through insurance in Ethiopia: State infrastructural power and the challenge of enrolment

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  • Lavers, Tom

Abstract

Many developing countries are considering insurance as a means of pursuing Universal Health Coverage. A key challenge to confront is how to achieve high levels of health insurance enrolment. For voluntary schemes this entails mass awareness raising and promotional activity, though as schemes move to compulsory enrolment, monitoring and enforcement are required. This paper focuses on Ethiopia, which has made state health insurance for the informal sector a central pillar of its Universal Health Coverage strategy. The paper shows that high enrolment requires particular forms of state capacity, captured by Michael Mann's concept of state ‘infrastructural power’. The paper draws on detailed case studies of insurance implementation in the Tigray and Oromiya regions of Ethiopia to illustrate variation in state infrastructural power and the implications for health insurance. Findings suggest that the potential of state health insurance as a means of promoting health access for a broad section of the population may be limited to the minority of countries or regions within countries exhibiting high levels of infrastructural power.

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  • Lavers, Tom, 2021. "Aiming for Universal Health Coverage through insurance in Ethiopia: State infrastructural power and the challenge of enrolment," Social Science & Medicine, Elsevier, vol. 282(C).
    • Handle: RePEc:eee:socmed:v:282:y:2021:i:c:s0277953621005062
    DOI: 10.1016/j.socscimed.2021.114174
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    References listed on IDEAS

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    1. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2015. "Enrollment in Ethiopia’s Community-Based Health Insurance Scheme," World Development, Elsevier, vol. 74(C), pages 58-76.
    2. Matthias vom Hau, 2012. "State capacity and inclusive development: new challenges and directions," Global Development Institute Working Paper Series esid-002-12, GDI, The University of Manchester.
    3. Rieger, Matthias & Wagner, Natascha & Mebratie, Anagaw & Alemu, Getnet & Bedi, Arjun, 2019. "The impact of the Ethiopian health extension program and health development army on maternal mortality: A synthetic control approach," Social Science & Medicine, Elsevier, vol. 232(C), pages 374-381.
    4. Yu, Hao, 2015. "Universal health insurance coverage for 1.3 billion people: What accounts for China's success?," Health Policy, Elsevier, vol. 119(9), pages 1145-1152.
    5. Lavers, Tom, 2019. "Towards Universal Health Coverage in Ethiopia's ‘developmental state’? The political drivers of health insurance," Social Science & Medicine, Elsevier, vol. 228(C), pages 60-67.
    6. Chemouni, Benjamin, 2018. "The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda," World Development, Elsevier, vol. 106(C), pages 87-98.
    7. Shigute, Zemzem & Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2017. "Uptake of health insurance and the productive safety net program in rural Ethiopia," Social Science & Medicine, Elsevier, vol. 176(C), pages 133-141.
    8. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Abebaw, Degnet & Alemu, Getnet & Bedi, Arjun S., 2019. "The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care," Social Science & Medicine, Elsevier, vol. 220(C), pages 112-119.
    9. Li, Cheng & Yu, Xuan & Butler, James R.G. & Yiengprugsawan, Vasoontara & Yu, Min, 2011. "Moving towards universal health insurance in China: Performance, issues and lessons from Thailand," Social Science & Medicine, Elsevier, vol. 73(3), pages 359-366, August.
    10. Bärnighausen, Till & Sauerborn, Rainer, 2002. "One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries?," Social Science & Medicine, Elsevier, vol. 54(10), pages 1559-1587, May.
    11. Maes, Kenneth & Closser, Svea & Tesfaye, Yihenew & Abesha, Roza, 2019. "Psychosocial distress among unpaid community health workers in rural Ethiopia: Comparing leaders in Ethiopia's Women's Development Army to their peers," Social Science & Medicine, Elsevier, vol. 230(C), pages 138-146.
    12. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    13. Christopher Clapham, 2009. "Post-war Ethiopia: The Trajectories of Crisis," Review of African Political Economy, Taylor & Francis Journals, vol. 36(120), pages 181-192, June.
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