Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments

Abstract Background: Community based health insurance is accepted as a capable tool of health system improvement and improves the health status of enrollees. Its mechanisms look for to protect low-income households from health related risks through mutual risk sharing at the community level. Even though Government’s efforts, the Community based health insurance enrolment rate remained low. Objective: To assess the community based health insurance enrollment and associated factors in Sidama Region, Ethiopia.Methods: A community based cross-sectional study was conducted in Sidama Region, 2020 using a pretested structured questionnaire. The study was conducted in randomly selected 770 households. The data entry was made by using Epi-info 2007 software. The data was analyzed by using SPSS version 20. Logistic regression statistical model was used to compute odds ratio with its 95% confidence interval to test the associations between dependent and independent variables. Then variables found to have P<0.25 in the bi-variable analysis taken as candidate for multivariable analysis. A P-value of 0.05 with a confidence interval of 95% was used to declare level of statistical significance. Result: Among 770 sampled households, 762 were interviewed and the response rate was 98.9%. About 20.2% of the respondents were enrolled in the scheme. Covariates such as፡ ages 31-59 years(AOR :2.62, 95% CI :1.48-4.66)and >=60 years(AOR : 2.87, 95% CI :1.23-6.74), households who had no formal education(AOR:1.66, 95% CI:1.02-2.72),affordability of premium (AOR:0.28, 95% CI: 0.15-0.54), knowledge on CBHI(AOR: 3.53; 95% CI: 1.21, 10.27) and perceived quality(AOR: 0.52, 95% CI: 0.25-0.87) had statistically significant association with community based health insurance enrollment.Conclusion: The prevalence of community based health insurance enrollment was low. This study identified the need to create knowledge and bring behavioral change in the community on the scheme in general. This study also revealed that regular contribution issue needs improvement based on affordability of households and building their trust on the program and efforts should be devoted to enhance quality of healthcare services to increase the enrollment.

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Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

BMC Health Services Research ◽

10.1186/1472-6963-12-159 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 15

Author(s):

Paul Jacob Robyn ◽

Till Bärnighausen ◽

Aurélia Souares ◽

Germain Savadogo ◽

Brice Bicaba ◽

...

Keyword(s):

Health Insurance ◽

Health Worker ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Community Based ◽

Community Based Health Insurance ◽

Insurance Payment ◽

Payment Mechanisms

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Faculty Opinions recommendation of Ordering effect and price sensitivity in discrete choice experiments: need we worry?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1061834.513772 ◽

2007 ◽

Author(s):

Eric Nauenberg

Keyword(s):

Discrete Choice ◽

Choice Experiments ◽

Discrete Choice Experiments ◽

Price Sensitivity

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The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process

BMC Health Services Research ◽

10.1186/s12913-021-06643-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ramadhani Kigume ◽

Stephen Maluka

Keyword(s):

Health Insurance ◽

Community Health ◽

Rural Areas ◽

Health Coverage ◽

Access To Health Services ◽

Community Based ◽

Community Based Health Insurance ◽

Urban Districts ◽

Health Fund ◽

The Government

Abstract Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.

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A Systematic and Critical Review of Discrete Choice Experiments in Asthma and Chronic Obstructive Pulmonary Disease

The Patient: Patient-Centered Outcomes Research ◽

10.1007/s40271-021-00536-w ◽

2021 ◽

Author(s):

Hannah Collacott ◽

Dian Zhang ◽

Sebastian Heidenreich ◽

Tommi Tervonen

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Discrete Choice ◽

Critical Review ◽

Choice Experiments ◽

Discrete Choice Experiments ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

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Application of discrete choice experiments to estimate value of life: a national study protocol in Iran

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00259-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Negar Mirzaee ◽

Amirhossein Takian ◽

Farshad Farzadfar ◽

Rajabali Daroudi ◽

Ali Kazemi Karyani ◽

...

Keyword(s):

Discrete Choice ◽

Premature Death ◽

Choice Experiments ◽

Value Of Life ◽

Discrete Choice Experiments ◽

National Study ◽

Middle Income ◽

Risk Levels ◽

Survey Interviews ◽

Economic Perspectives

Abstract Background Global concerns regarding the significant burden of non-communicable diseases and injuries (NCDIs) exist from both public health and economic perspectives. Our research focuses on the reduction of fatal risks due to NCDIs and the citizens’ preferences about health programs and intervention to reduce premature death due to NCDIs. Governments and health authorities need reliable evidence and information to prioritize the interests of their citizens. One crucial piece of evidence to justify the resources spent on NCDIs is the value derived from the interventions on prevention and NCDIs control. This concept is usually called “Value of Statistical Life” (VSL), meaning the monetary value that individuals place on changes in the risk levels of life- threatening events. To the best of our knowledge, for the first time, our study will estimate the statistical value of life for selected interventions for the prevention and control of NCDIs at both national and sub-national levels in the context of Iran. This paper reports the development of a national protocol through Discrete Choice Experiments (DCEs) method. Methods and designs Our study comprises several stages: (a) a literature review to identify the attributes and levels of the prevention programs and Willingness to Pay (WTP) for reducing the NCDI’s fatal risks; (b) experimental design to assessing, prioritizing, and finalizing the identified attributes and levels; (c) instrumental design to conduct face-to-face structured survey interviews of 3180 respondents aged 18–69 across the entire country; (d) statistical analysis to estimate the results through the Mixed Multinomial logit (MMNL) model. Discussion We anticipate that our findings will help build a stronger empirical basis for monetizing the value of small changes in selected fatality risks. It paves the way for other national or vast VSL estimates for NCDIs, as well as other major causes of morbidity and mortality in the context of Iran, and perhaps other low and middle-income countries (LMICs).

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The Impact of Environmental Sustainability Labels on Willingness-to-Pay for Foods: A Systematic Review and Meta-Analysis of Discrete Choice Experiments

Nutrients ◽

10.3390/nu13082677 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2677

Author(s):

Anastasios Bastounis ◽

John Buckell ◽

Jamie Hartmann-Boyce ◽

Brian Cook ◽

Sarah King ◽

...

Keyword(s):

Willingness To Pay ◽

Discrete Choice ◽

Environmental Sustainability ◽

Purchasing Power Parity ◽

Meta Analysis ◽

Choice Experiments ◽

Discrete Choice Experiments ◽

Environmental Damage ◽

Environmentally Sustainable ◽

The Impact

Food production is a major contributor to environmental damage. More environmentally sustainable foods could incur higher costs for consumers. In this review, we explore whether consumers are willing to pay (WTP) more for foods with environmental sustainability labels (‘ecolabels’). Six electronic databases were searched for experiments on consumers’ willingness to pay for ecolabelled food. Monetary values were converted to Purchasing Power Parity dollars and adjusted for country-specific inflation. Studies were meta-analysed and effect sizes with confidence intervals were calculated for the whole sample and for pre-specified subgroups defined as meat-dairy, seafood, and fruits-vegetables-nuts. Meta-regressions tested the role of label attributes and demographic characteristics on participants’ WTP. Forty-three discrete choice experiments (DCEs) with 41,777 participants were eligible for inclusion. Thirty-five DCEs (n = 35,725) had usable data for the meta-analysis. Participants were willing to pay a premium of 3.79 PPP$/kg (95%CI 2.7, 4.89, p ≤ 0.001) for ecolabelled foods. WTP was higher for organic labels compared to other labels. Women and people with lower levels of education expressed higher WTP. Ecolabels may increase consumers’ willingness to pay more for environmentally sustainable products and could be part of a strategy to encourage a transition to more sustainable diets.

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Impact of community-based health insurance on utilisation of preventive health services in rural Uganda: a propensity score matching approach

International Journal of Health Economics and Management ◽

10.1007/s10754-021-09294-6 ◽

2021 ◽

Author(s):

Emmanuel Nshakira-Rukundo ◽

Essa Chanie Mussa ◽

Nathan Nshakira ◽

Nicolas Gerber ◽

Joachim von Braun

Keyword(s):

Developing Countries ◽

Health Insurance ◽

Propensity Score ◽

Propensity Score Matching ◽

Information Diffusion ◽

Preventive Health ◽

Financial Protection ◽

Community Based ◽

Research Attention ◽

Community Based Health Insurance

AbstractThe effect of voluntary health insurance on preventive health has received limited research attention in developing countries, even when they suffer immensely from easily preventable illnesses. This paper surveys households in rural south-western Uganda, which are geographically serviced by a voluntary Community-based health insurance scheme, and applied propensity score matching to assess the effect of enrolment on using mosquito nets and deworming under-five children. We find that enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%. We postulate that these findings are partly mediated by information diffusion and social networks, financial protection, which gives households the capacity to save and use service more, especially curative services that are delivered alongside preventive services. This paper provides more insight into the broader effects of health insurance in developing countries, beyond financial protection and utilisation of hospital-based services.

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