scholarly journals Continued Adherence to Community-Based Health Insurance Scheme in Two Districts of Northeast Ethiopia: Application of Accelerated Failure Time Shared Frailty Models

2021 ◽  
Author(s):  
Mohammed Hussien ◽  
Muluken Azage ◽  
Negalign Berhanu Bayou
Keyword(s):  
Health Insurance ◽  
Failure Time ◽  
Multivariable Analysis ◽  
Drop Out ◽  
Accelerated Failure Time ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Shared Frailty ◽  
Risk Protection

Abstract Background: The sustainability of a voluntary community-based health insurance scheme depends to a greater extent on its ability to retain members. In low- and middle-income countries, high rate of member dropout has been a great concern for such schemes. Although few studies had investigated the factors influencing dropout decisions, none of these looked into how long and why members adhere to the scheme. The purpose of this study was to determine the factors affecting time to drop out while accounting for the influence of cluster-level variables. Methods: A community-based cross-sectional study was conducted among 1232 rural households who have ever been enrolled in two community-based health insurance schemes. A household survey was conducted using a mobile data collection platform. The Kaplan-Meier estimates were used to compare the time to drop out among subgroups. To identify predictors of time to drop out, a multivariable analysis was done using the accelerated failure time shared frailty models. The degree of association was assessed using the acceleration factor (δ) and statistical significance was determined at 95% confidence interval. Results: Results of the multivariable analysis revealed that marital status of the respondents (δ=1.614; 95% CI: 1.221–2.134), household size (δ=1.167; 95% CI: 1.012–1.344), presence of chronic illness (δ=1.421; 95% CI: 1.163–1.736), hospitalization history (δ=1.308; 95% CI: 1.120–1.529), higher perceived quality of care (δ=1.323; 95% CI: 1.101–1.589), perceived risk protection (δ=1.220; 95% CI: 1.029–1.446), and higher trust in the scheme (δ=1.729; 95% CI: 1.428–2.095) were significant predictors of time to drop out at p-value < 0.05. Conclusions: The study identified evidence suggestive of adverse selection in the schemes. The fact that larger households remain in the scheme indicates the need to reconsider the premium level in line with household size to attract small size households. Issues that are under the control of the scheme and the healthcare system can be adjusted to increase membership adherence. Resolving problems related to the quality of health care can be a cross-cutting area of ​​intervention to retain members by building trust in the scheme and enhancing the risk protection ability of the schemes.

scholarly journals Factors affecting enrollment status of households for community based health insurance in a resource-limited peripheral area in Southern Ethiopia. Mixed method

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245952
Author(s):  
Mustefa Glagn Abdilwohab ◽  
Zeleke Hailemariam Abebo ◽  
Wanzahun Godana ◽  
Dessalegn Ajema ◽  
Manaye Yihune ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Insurance ◽  
Multivariable Analysis ◽  
Southern Ethiopia ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Wide Range ◽  
Enrollment Status

Background Despite the efforts made by the government of Ethiopia, the community-based health insurance (CBHI) enrollment rate failed to reach the potential beneficiaries. Therefore, this study aimed to assess the enrollment status of households for community-based health insurance and associated factors in peripheral areas of Southern Ethiopia. Methods We conducted a community based cross-sectional study design with both quantitative and qualitative methods. Systematic random sampling was employed to select 820 households from 27, April to 12 June 2018. A pretested structured questionnaire, in-depth interview, and focus group discussion guiding tool were used to obtain information. A binary logistic regression model was used to assess the association between independent and outcome variables. A P-Value of less than 0.05 was taken as a cutoff to declare association in multivariable analysis. Qualitative data were analyzed manually using the thematic analysis method. Results Out of 820 households, 273[33.30%; 95% CI: 29.9–36.20] were enrolled in the community based health insurance scheme. Having good knowledge [AOR = 13.97, 95%CI: 8.64, 22.60], having family size of greater than five [AOR = 1.88, 95% CI: 1.15, 3.06], presence of frequently ill individual [AOR = 3.90, 95% CI: 2.03, 7.51] and presence of chronic illness [AOR = 3.64, 95% CI: 1.67, 7.79] were positively associated with CBHI enrollment. In addition, poor quality of care, lack of managerial commitment, lack of trust and transparency, unavailability of basic logistics and supplies were also barriers for CBHI enrollment. Conclusion and recommendation The study found that lower community based health insurance enrollment status. A higher probability of CBHI enrollment among higher health care demanding population groups was observed. Poor perceived quality of health care, poor managerial support and lack of trust were found to be barriers for non-enrollment. Therefore, wide-range awareness creation strategies should be used to address adverse selection and poor knowledge. In addition, trust should be built among communities through transparent management. Furthermore, the quality of care being given in public health facilities should be improved to encourage the community to be enrolled in CBHI.

scholarly journals Feasibility and Desirability of Scaling up Community –based Health Insurance (CBHI) in rural communities in Uganda. Lessons from Kisiizi hospital CBHI scheme.

2019 ◽  
Author(s):  
ALEX KAKAMA AYEBAZIBWE
Keyword(s):  
Health Insurance ◽  
Health Financing ◽  
Scaling Up ◽  
Healthcare Services ◽  
Community Based ◽  
Leadership And Management ◽  
Community Based Health Insurance ◽  
Community Associations ◽  
Key Informant

Abstract Background Community-based health Insurance (CBHI) schemes have been implemented world over as initial steps for National Health Insurance. The CBHI concept developed out of a need for financial protection against catastrophic health expenditure to the poor after failure of other health financing mechanisms. CBHI schemes reduce out-of-pocket payments, and improve access to healthcare services in addition to raising additional revenue for health sector. Kisiizi hospital CBHI scheme has 41,500 registered members since 1996, organised in 210 community associations known as ‘Bataka’ or ‘Engozi’ societies. Members pay annual premium fees and a co-payment fee before service utilisation. This Study aimed at exploring the feasibility and desirability of scaling up CBHI in Rubabo County, with objectives of; exploring community perceptions and determining acceptability of CBHI, identifying barriers and enablers to scaling up CBHI and documenting lessons regarding CBHI expansion in a rural community. Method: Explorative study using qualitative methods. Key informant interviews and Focus Group Discussions (FGD) were used in data collection. Twenty two key informant interviews were conducted using semi-structured questionnaires. Three FGD for scheme members and three for non-scheme members were conducted. Data was analysed using thematic approach. Results : Scaling up Kisiizi hospital CBHI is desirable because: it conforms to the government social protection agenda, conforms to society values, offers a comprehensive benefits package, and is a better healthcare financing alternative for many households. Scaling up Kisiizi hospital CBHI is largely feasible because of a strong network of community associations, trusted quality of services at Kisiizi Hospital, affordable insurance fees, and trusted leadership and management systems. Scheme expansion faces a few obstacles: long distances and high transport costs to Kisiizi hospital, low levels of knowledge about insurance, overlapping financial priorities at household level and inability of some households to pay insurance fees. Conclusions CBHI implementation requires the following considerations: Conformity with society values and government priorities, a comprehensive benefits package, trusted quality of healthcare services, affordable fees, and trusted leadership and management systems. Key words Community-based Health Insurance, Universal Health Coverage, Health financing, Enrolment

scholarly journals The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care

2020 ◽  
Vol 17 (22) ◽  
pp. 8558
Author(s):  
Zemzem Shigute ◽  
Anagaw D. Mebratie ◽  
Robert Sparrow ◽  
Getnet Alemu ◽  
Arjun S. Bedi
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Insurance ◽  
Access To Health Care ◽  
Sub Saharan Africa ◽  
Community Based ◽  
Community Based Health Insurance ◽  
The Impact

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Africa.

scholarly journals Community Based Health Insurance Enrollment and Associated Factors in Sidama Region, Ethiopia

2020 ◽  
Author(s):  
Berhanu Bifato ◽  
Amanuel Ayele ◽  
Muse Rike ◽  
Dalecha Dangura
Keyword(s):  
Health Insurance ◽  
Confidence Interval ◽  
Low Income ◽  
Associated Factors ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
P Value ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Insurance Enrollment

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.

Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso

Health Policy ◽  
2009 ◽  
Vol 92 (2-3) ◽  
pp. 174-179 ◽  
Author(s):  
Hengjin Dong ◽  
Manuela De Allegri ◽  
Devendra Gnawali ◽  
Aurélia Souares ◽  
Rainer Sauerborn
Keyword(s):  
Health Insurance ◽  
Burkina Faso ◽  
Drop Out ◽  
Community Based ◽  
Community Based Health Insurance

scholarly journals Do household perceptions influence enrolment decisions into community-based health insurance schemes in Tanzania?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alphoncina Kagaigai ◽  
Amani Anaeli ◽  
Amani Thomas Mori ◽  
Sverre Grepperud
Keyword(s):  
Health Insurance ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Principal Component ◽  
Insurance Scheme ◽  
Community Based ◽  
Cross Sectional ◽  
Community Based Health Insurance ◽  
Logistic Regressions

Abstract Background Several countries including Tanzania, have established voluntary non-profit insurance schemes, commonly known as community-based health insurance schemes (CBHIs), that typically target rural populations and the informal sector. This paper considers the importance of household perceptions towards CBHIs in Tanzania and their role in explaining the enrolment decision of households. Methods This was a cross-sectional household survey that involved 722 households located in Bahi and Chamwino districts in the Dodoma region. A three-stage sampling procedure was used, and the data were analyzed using both factor analysis (FA) and principal component analysis (PCA). Statistical tests such as Bartlett’s test of sphericity, Kaiser-Meyer-Olkin (KMO) for sampling adequacy, and Cronbach’s alpha test for internal consistency and scale reliability were performed to examine the suitability of the data for PCA and FA. Finally, multivariate logistic regressions were run to determine the associations between the identified factors and the insurance enrolment status. Results The PCA identified seven perception factors while FA identified four factors. The quality of healthcare services, preferences (social beliefs), and accessibility to insurance scheme administration (convenience) were the most important factors identified by the two methods. Multivariate logistic regressions showed that the factors identified from the two methods differed somewhat in importance when considered as independent predictors of the enrollment status. The most important perception factors in terms of strength of association (odds ratio) and statistical significance were accessibility to insurance scheme administration (convenience), preferences (beliefs), and the quality of health care services. However, age and income were the only socio-demographic characteristics that were statistically significant. Conclusion Household perceptions were found to influence households’ decisions to enroll in CBHIs. Policymakers should recognize and consider these perceptions when designing policies and programs that aim to increase the enrolment into CBHIs.

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