ArticleBMC health services research2023
Effect of community-based health insurance on catastrophic health expenditure among chronic disease patients in Asella referral hospital, Southeast Ethiopia: a comparative cross-sectional study.
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 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effects of health insurance on economic burden and health service utilization among people with noncommunicable diseases in low- and middle-income countries: a systematic review.BMC public health · 2026Pooled it
- Article
- The effect of community-based health insurance on healthcare utilization and out-of-pocket health expenditure in the Tigray Regional State, Ethiopia.International journal of health economics and management · 2026Article
- The effect of community-based health insurance on out-of-pocket expenditure among diabetic patients at hawassa university comprehensive specialized hospital: facility-based comparative cross-sectional study.BMC health services research · 2026Article
- The Impact of Community-Based Health Insurance Scheme on Patient Satisfaction in Debresina, Primary Hospital, North Shewa Zone, Ethiopia: A Comparative Cross-Sectional Study.Health science reports · 2026Article
- The Impact of Community-Based Health Insurance on Catastrophic Health Care Expenditure: A Cross-Sectional Study From Ethiopia.Health science reports · 2026Article
- Willingness of Urban Formal Sector Workers to Support a Community-Based Health Insurance Scheme in Ethiopia.ClinicoEconomics and outcomes research : CEOR · 2025Article
- Out-of-pocket and indirect expenditure of spina bifida and hydrocephalus patients admitted for inpatient treatment and follow-up at two university-affiliated hospitals in Ethiopia.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024Article
- The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review.Health promotion international · 2024Article
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3 authors.
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Abstract
backgroundChronic disease-related catastrophic health spending is frequent in Ethiopia affecting several households, particularly the poorest ones. A community-based health insurance (CBHI) scheme has been in place in Ethiopia since 2011. The scheme aims to provide financial protection against health expenditure but there is little evidence of how well it protects chronic patients financially.
objectiveThe objective of the study was to evaluate the effect of community-based health insurance in reducing the incidence of catastrophic health expenditure among patients attending chronic disease follow-up departments in Asella referral hospital, Southeast Ethiopia.
methodA health facility-based comparative cross-sectional study was conducted in Asella referral hospital from March 2022 to May 2022. Systematic random sampling was used to select 325 chronic patients. Data were collected using an open data kit (ODK) collect app and then imported to STATA version 16 for analysis. Propensity score matching was used to evaluate the effect of community-based health insurance on catastrophic health expenditure.
resultThe study enrolled a total of 325 chronic patients (157 insurance members and 168 nonmembers). More than 30% of the study participants incurred health spending that could be catastrophic based on the 15% nonfood threshold. Catastrophic health expenditure was found in 31% of insured and 47% of uninsured participants. Overshoot and mean positive overshoot were 10% and 33% for insured members, respectively and the corresponding figures were 18% and 39% for nonmembers. Community-based health insurance contributes to a 19% ((ATT = -0.19, t = -2.97)) reduction in the incidence of catastrophic health expenditure among chronic patients. This result is found to be consistent for alternative measurements of the outcome variable and the use of alternative matching algorithms.
conclusionChronic patients, particularly those in uninsured households, had a high incidence and intensity of catastrophic health expenditure. Hence, it is relevant to expand community-based health insurance to provide financial protection for people suffering from chronic conditions.
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