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The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study

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  • Asnakew Molla Mekonen
  • Measho Gebreslassie Gebregziabher
  • Alemayehu Shimeka Teferra

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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  • Asnakew Molla Mekonen & Measho Gebreslassie Gebregziabher & Alemayehu Shimeka Teferra, 2018. "The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-13, October.
    • Handle: RePEc:plo:pone00:0205972
    DOI: 10.1371/journal.pone.0205972
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    1. Phuong Huu Khiem & Yu-Chen Kuo, 2022. "Health insurance reform impact on children’s educational attainment: evidence from Vietnam," Review of Economics of the Household, Springer, vol. 20(4), pages 1255-1285, December.
    2. Abdul-Aziz Seidu, 2020. "Mixed effects analysis of factors associated with barriers to accessing healthcare among women in sub-Saharan Africa: Insights from demographic and health surveys," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-16, November.
    3. Nguyen Thi Thu Thuong & Yme Van Den Berg & Tran Quang Huy & Do Anh Tai & Bui Nu Hoang Anh, 2021. "Determinants of catastrophic health expenditure in Vietnam," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 316-333, March.
    4. Yawkal Tsega & Gebeyehu Tsega & Asnakew Molla Mekonen & Tesfaye Birhane & Elsabeth Addisu & Abebe Getie & Fekade Demeke Bayou & Mulugeta Desalegn Kasaye & Natnael Kebede & Amare Muche, 2024. "Insured-non-insured disparity of catastrophic health expenditure in Northwest Ethiopia: a multivariate decomposition analysis," Health Economics Review, Springer, vol. 14(1), pages 1-11, December.
    5. Dawit Nageso & Kebede Tefera & Keneni Gutema, 2020. "Enrollment in community based health insurance program and the associated factors among households in Boricha district, Sidama Zone, Southern Ethiopia; a cross-sectional study," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-14, June.

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