IDEAS home Printed from https://ideas.repec.org/p/iza/izadps/dp10939.html
   My bibliography  Save this paper

The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia

Author

Listed:
  • Shigute, Zemzem

    (ISS, Erasmus University Rotterdam)

  • Strupat, Christoph

    (German Development Institute)

  • Burchi, Francesco

    (German Development Institute)

  • Alemu, Getnet

    (University of Addis Ababa, Ethiopia)

  • Bedi, Arjun S.

    (ISS, Erasmus University Rotterdam)

Abstract

Rural households in Ethiopia are exposed to a variety of covariate and idiosyncratic risks. In 2005, the Ethiopian government introduced the Productive Safety Net Program (PSNP) and in 2011 launched the Community Based Health Insurance Scheme (CBHI). This paper analyses the interaction between the two schemes and their joint effect on health care utilization, labor supply, asset accumulation and borrowing. The empirical analysis relies on three rounds of individual-level panel data collected in 2011, 2012 and 2013 and on several rounds of qualitative work. We find that individuals covered by both programs, as opposed to neither, are 5 percentage points more likely to use outpatient care and are 21 percentage points more likely to participate in off-farm work. Furthermore, participation in both programs is associated with a 5 percent increase in livestock, the main household asset, and a 27 percent decline in debt. These results suggest that at least in Ethiopia bundling of interventions enhances protection against multiple risks and shows the potential of linked social protection schemes.

Suggested Citation

  • Shigute, Zemzem & Strupat, Christoph & Burchi, Francesco & Alemu, Getnet & Bedi, Arjun S., 2017. "The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia," IZA Discussion Papers 10939, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp10939
    as

    Download full text from publisher

    File URL: https://docs.iza.org/dp10939.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Syed Abdul Hamid & Jennifer Roberts & Paul Mosley, 2011. "Can Micro Health Insurance Reduce Poverty? Evidence From Bangladesh," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 78(1), pages 57-82, March.
    2. 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.
    3. Jere R. Behrman & John Hoddinott, 2005. "Programme Evaluation with Unobserved Heterogeneity and Selective Implementation: The Mexican PROGRESA Impact on Child Nutrition," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 67(4), pages 547-569, August.
    4. Dercon, Stefan, 2004. "Growth and shocks: evidence from rural Ethiopia," Journal of Development Economics, Elsevier, vol. 74(2), pages 309-329, August.
    5. Sudhanshu Handa & Benjamin Davis & Marco Stampini & Paul Winters, 2010. "Heterogeneous treatment effects in conditional cash transfer programmes: assessing the impact of Progresa on agricultural households," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 2(3), pages 320-335.
    6. Jensen, Nathaniel D. & Barrett, Christopher B. & Mude, Andrew G., 2017. "Cash transfers and index insurance: A comparative impact analysis from northern Kenya," Journal of Development Economics, Elsevier, vol. 129(C), pages 14-28.
    7. Daniel Gilligan & John Hoddinott & Alemayehu Seyoum Taffesse, 2009. "The Impact of Ethiopia's Productive Safety Net Programme and its Linkages," Journal of Development Studies, Taylor & Francis Journals, vol. 45(10), pages 1684-1706.
    8. repec:idb:brikps:59558 is not listed on IDEAS
    9. repec:zbw:rwirep:0432 is not listed on IDEAS
    10. Cristian C. Baeza & Truman G. Packard, 2006. "Beyond Survival : Protecting Households from Health Shocks in Latin America," World Bank Publications - Books, The World Bank Group, number 7120.
    11. Salvatore Di Falco & Marcella Veronesi & Mahmud Yesuf, 2011. "Does Adaptation to Climate Change Provide Food Security? A Micro-Perspective from Ethiopia," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 93(3), pages 825-842.
    12. Andersson, Camilla & Mekonnen, Alemu & Stage, Jesper, 2011. "Impacts of the Productive Safety Net Program in Ethiopia on livestock and tree holdings of rural households," Journal of Development Economics, Elsevier, vol. 94(1), pages 119-126, January.
    13. 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.
    14. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Degnet Abebaw & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2014. "Coping with shocks in rural Ethiopia," Journal of Development Studies, Taylor & Francis Journals, vol. 50(7), pages 1009-1024, July.
    15. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2015. "Impact of Ethiopia's Community Based Health Insurance on Household Economic Welfare," The World Bank Economic Review, World Bank, vol. 29(suppl_1), pages 164-173.
    16. Klohn, Florian & Strupat, Christoph, 2013. "Crowding out of Solidarity? – Public Health Insurance versus Informal Transfer Networks in Ghana," Ruhr Economic Papers 432, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    17. José A. Pagán & Andrea Puig & Beth J. Soldo, 2007. "Health insurance coverage and the use of preventive services by Mexican adults," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1359-1369.
    18. Ravallion, Martin, 1991. "Reaching the Rural Poor through Public Employment: Arguments, Evidence, and Lessons from South Asia," The World Bank Research Observer, World Bank, vol. 6(2), pages 153-175, July.
    19. Abhijit Banerjee & Esther Duflo & Richard Hornbeck, 2014. "Bundling Health Insurance and Microfinance in India: There Cannot Be Adverse Selection If There Is No Demand," American Economic Review, American Economic Association, vol. 104(5), pages 291-297, May.
    20. K. Subbarao, 1997. "Public Works as an Anti-Poverty Program: An Overview of Cross-Country Experience," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 79(2), pages 678-683.
    21. Bender, Katja, 2011. "Health Financing Mechanisms, Access to Health and Economic Growth," IEE Working Papers 192, Ruhr University Bochum, Institute of Development Research and Development Policy (IEE).
    22. Jensen, Nathaniel & Barrett, Christopher B. & Mude, Andrew, 2014. "Index Insurance and Cash Transfers: A Comparative Analysis from Northern Kenya," MPRA Paper 61372, University Library of Munich, Germany.
    23. Truman G. Packard & Cristian C. Baeza, 2006. "Beyond Survival: Protecting Households from Health Shocks in Latin America," IDB Publications (Books), Inter-American Development Bank, number 59558, February.
    24. Subbarao, Kalanidhi, 2003. "Systemic shocks and social protection : role and effectiveness of public works programs," Social Protection and Labor Policy and Technical Notes 25606, The World Bank.
    25. Paul Gertler, 2004. "Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA's Control Randomized Experiment," American Economic Review, American Economic Association, vol. 94(2), pages 336-341, May.
    26. Subbarao,Kalanidhi, 2003. "Systemic shocks and social protection : role and effectiveness of public works programs," Policy Research Working Paper Series 25606, The World Bank.
    27. José A. Pagán & Andrea Puig & Beth J. Soldo, 2007. "Health insurance coverage and the use of preventive services by Mexican adults," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1359-1369, December.
    28. Kent Ranson, M. & Sinha, Tara & Chatterjee, Mirai & Acharya, Akash & Bhavsar, Ami & Morris, Saul S. & Mills, Anne J., 2006. "Making health insurance work for the poor: Learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India," Social Science & Medicine, Elsevier, vol. 62(3), pages 707-720, February.
    29. Limwattananon, Supon & Neelsen, Sven & O'Donnell, Owen & Prakongsai, Phusit & Tangcharoensathien, Viroj & van Doorslaer, Eddy & Vongmongkol, Vuthiphan, 2015. "Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand," Journal of Public Economics, Elsevier, vol. 121(C), pages 79-94.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. World Bank Group & U.K. Department of International Development, 2019. "Poverty and Vulnerability in the Ethiopian Lowlands," World Bank Publications - Reports 33422, The World Bank Group.
    2. Strupat, Christoph & Klohn, Florian, 2018. "Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana," World Development, Elsevier, vol. 104(C), pages 212-221.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Maione, Carol, 2020. "Adapting to drought and extreme climate: Hunger Safety Net Programme, Kenya," World Development Perspectives, Elsevier, vol. 20(C).
    2. 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.
    3. Wong, Ho Lun & Wei, Xiangdong & Kahsay, Haftom Bayray & Gebreegziabher, Zenebe & Gardebroek, Cornelis & Osgood, Daniel E. & Diro, Rahel, 2020. "Effects of input vouchers and rainfall insurance on agricultural production and household welfare: Experimental evidence from northern Ethiopia," World Development, Elsevier, vol. 135(C).
    4. 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).
    5. Zulkhibri, Muhamed, 2016. "Conditional Cash Transfers in Developing Economy: The Case of Muslim Countries," Working Papers 2016-6, The Islamic Research and Teaching Institute (IRTI).
    6. Milan Vodopivec, 2004. "Income Support for the Unemployed : Issues and Options," World Bank Publications - Books, The World Bank Group, number 14922.
    7. Milan Vodopivec, 2006. "Choosing a System of Unemployment Income Support: Guidelines for Developing and Transition Countries," The World Bank Research Observer, World Bank, vol. 21(1), pages 49-89.
    8. Kalle Hirvonen & Anne Bossuyt & Remy Pigois, 2021. "Evidence from the Productive Safety Net Programme in Ethiopia: Complementarities between social protection and health policies," Development Policy Review, Overseas Development Institute, vol. 39(4), pages 532-547, July.
    9. Lara Cockx & Nathalie Francken, 2016. "Evolution and impact of EU aid for food and nutrition security: a review," Working Papers of Department of Economics, Leuven 540512, KU Leuven, Faculty of Economics and Business (FEB), Department of Economics, Leuven.
    10. Nshakira-Rukundo, Emmanuel & Mussa, Essa Chanie & Gerber, Nicolas & von Braun, Joachim, 2020. "Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda," Social Science & Medicine, Elsevier, vol. 245(C).
    11. Lovo, Stefania & Veronesi, Marcella, 2019. "Crop Diversification and Child Health: Empirical Evidence From Tanzania," Ecological Economics, Elsevier, vol. 158(C), pages 168-179.
    12. Narayanan, Sudha & Das, Upasak & Liu, Yanyan & Barrett, Christopher B., 2017. "The “Discouraged Worker Effect” in Public Works Programs: Evidence from the MGNREGA in India," World Development, Elsevier, vol. 100(C), pages 31-44.
    13. Ngigi, Marther W. & Müller, Ulrike & Birner, Regina, 2015. "The role of livestock portfolios and group-based approaches for building resilience in the face of accelerating climate change: An asset-based panel data analysis from rural Kenya," Discussion Papers 210703, University of Bonn, Center for Development Research (ZEF).
    14. Subhasish Dey & Katsushi S. Imai, 2014. "Workfare as "Collateral": The Case of the National Rural Employment Guarantee Scheme (NREGS) in India," Economics Discussion Paper Series 1412, Economics, The University of Manchester.
    15. Yonas Alem & Nzinga H. Broussard, 2018. "The impact of safety nets on technology adoption: a difference†in†differences analysis," Agricultural Economics, International Association of Agricultural Economists, vol. 49(1), pages 13-24, January.
    16. Babu, Suresh Chandra, 2002. "Social Safety Nets for Poverty Reduction in South Asia – Global Experiences," Sri Lankan Journal of Agricultural Economics, Sri Lanka Agricultural Economics Association (SAEA), vol. 5, pages 1-9.
    17. World Bank, 2012. "Resilience, Equity, and Opportunity [Capacidad de recuperación, equidad y oportunidades]," World Bank Publications - Reports 12648, The World Bank Group.
    18. Mussa, Essa Chanie & Otchere, Frank & Vinci, Vincenzo & Reshad, Abduljelil & Palermo, Tia, 2021. "Linking poverty-targeted social protection and Community Based Health Insurance in Ethiopia: Enrolment, linkages, and gaps," Social Science & Medicine, Elsevier, vol. 286(C).
    19. Wodon, Quentin & Zaman, Hassan, 2008. "Rising food prices in Sub-Saharan Africa : poverty impact and policy responses," Policy Research Working Paper Series 4738, The World Bank.
    20. Misganaw Teshager Abeje & Atsushi Tsunekawa & Nigussie Haregeweyn & Zemen Ayalew & Zerihun Nigussie & Daregot Berihun & Enyew Adgo & Asres Elias, 2020. "Multidimensional Poverty and Inequality: Insights from the Upper Blue Nile Basin, Ethiopia," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 149(2), pages 585-611, June.

    More about this item

    Keywords

    Productive Safety Net Program; Community Based Health Insurance Scheme; Ethiopia; joint effect;
    All these keywords.

    JEL classification:

    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:iza:izadps:dp10939. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Holger Hinte (email available below). General contact details of provider: https://edirc.repec.org/data/izaaade.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.