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The interaction of healthcare service quality and community-based health insurance in Ethiopia

Author

Listed:
  • Bekele Belayihun Tefera
  • Mengistu Asnake Kibret
  • Yordanos B Molla
  • Girma Kassie
  • Aynalem Hailemichael
  • Tarekegn Abate
  • Hailu Zelelew
  • Binyam Fekadu Desta
  • Elizabeth Futrell
  • Zewditu Kebede
  • Gebeyehu Abelti
  • Subrata Routh
  • Bamikale Feyisetan
  • Abdulmumin Saad

Abstract

Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.

Suggested Citation

  • Bekele Belayihun Tefera & Mengistu Asnake Kibret & Yordanos B Molla & Girma Kassie & Aynalem Hailemichael & Tarekegn Abate & Hailu Zelelew & Binyam Fekadu Desta & Elizabeth Futrell & Zewditu Kebede & , 2021. "The interaction of healthcare service quality and community-based health insurance in Ethiopia," PLOS ONE, Public Library of Science, vol. 16(8), pages 1-16, August.
    • Handle: RePEc:plo:pone00:0256132
    DOI: 10.1371/journal.pone.0256132
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    References listed on IDEAS

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    1. Hirvonen, Kalle & Bossuyt, Anne & Pigois, Remy, 2017. "Complementarities between social protection and health sector policies: Evidence from the Productive Safety Net Program in Ethiopia," ESSP working papers 112, International Food Policy Research Institute (IFPRI).
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    4. Arnab Acharya & Sukumar Vellakkal & Fiona Taylor & Edoardo Masset & Ambika Satija & Margaret Burke & Shah Ebrahim, 2013. "The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review," The World Bank Research Observer, World Bank, vol. 28(2), pages 236-266, August.
    5. David M. Dror & Christian Jacquier, 1999. "Micro‐insurance: Extending Health Insurance to the Excluded," International Social Security Review, John Wiley & Sons, vol. 52(1), pages 71-97.
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