Evidence map›Paper›PMID 36683041›Full record

ArticleBMC health services research2023

The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia.

Yibeltal Kiflie Alemayehu, Ermias Dessie, Girmay Medhin, Negalign Birhanu, David R Hotchkiss, Alula M Teklu, Mizan Kiros

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 8 pooled it
14.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 8 syntheses or guidelines pooled it, 50 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 4 countries.

Yibeltal Kiflie Alemayehu *MERQ Consultancy PLC, Addis Ababa, Ethiopia. yibeltal.k@merqconsultancy.org.ORCID http://orcid.org/0000-0002-1781-0777
Ermias Dessie *World Health Organization - Ethiopia, Addis Ababa, Ethiopia.
Girmay MedhinMERQ Consultancy PLC, Addis Ababa, Ethiopia.
Negalign BirhanuDepartment of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.
David R HotchkissSchool of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
Alula M TekluMERQ Consultancy PLC, Addis Ababa, Ethiopia.
Mizan KirosMinistry of Health, Addis Ababa, Ethiopia.
21c Consultancy (United Kingdom) · GBJimma University · ETTulane University · USWorld Health Organization - Pakistan · PK

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundEvidence 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.

methodsWe 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.

resultsThe 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).

conclusionCBHI 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.

Indexed as

Community-Based Health InsuranceCommunity Health ServicesCross-Sectional StudiesEthiopiaHealth ExpendituresHealth ServicesHumansInsurance, HealthCommunity-based health insuranceEthiopiaFinancial risk protectionHealth care utilizationHealth financing

Identifiers

PMID36683041
PMCPMC9869550
OpenAlexW4317716365

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.