Role of Community Based Health Insurance on Health Service provision and Healthcare Seeking Behavior of Households in Rural Ethiopia: the Case of Tehuledere District, South Wollo Zone
No Thumbnail Available
Date
2017-06
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Ababa University
Abstract
The issue of community based health insurance is an emerging and promising concept to access
affordable and effective health care in low and middle income countries. Introduction of CBHI
scheme aims to mobilize additional resources to the health sector. More importantly,
substantially pooling risks between the poor and the better off as well as the sick and healthy
that improve equity, quality and access in health service delivery. In addition, as a health
insurance scheme removes or considerably reduce cash requirement at the point of getting
services, members will be encouraged to seek service when it is needed which ultimately
increase the demand for seeking care and utilization of the service. However, CBHI is limited in
most developing countries and out of pocket health care expenditure still impoverishes
households especially in rural and people in informal sector. So far, little has been done
regarding the role of CBHI on health care seeking behavior, access and quality of services in
developing countries in general and in Ethiopia in particular. Accordingly, the main objective of
this study was to examine services provision of health care providers and health care seeking
behavior of households in response to the introduction of CBHI scheme in rural Ethiopia:
particularly in Tehuledere District, South Wollo Zone. To conduct this study, mixed research
approach employed concurrently to gather data from 344 respondents (70% male and 30%
female) for household survey and informants of IDIs, KIIs and FGDs. The quantitative data were
analyzed using descriptive statistics such as table, percentage and graph on one hand, and
inferential statistics like, T-Test, one way ANOVA and correlation on the other hand were used
to verify the group difference and relationship across variables. Qualitative data were analyzed
using thematic analysis. The sampling design of this study used both probability (multistage
stage proportional sampling) and non-probability (purposive based on conveniences and
judgmental sampling until saturation achieved). The study finding disclosed that in some
parameters there were gaps in design and implementation of CBHI scheme. In addition, overall
quality of service improved though there were limitations in some quality indicator. Health
services utilization improved from 0.33 visits of individual per year in 2011 to 1.44 visits in
2016; more than four times from the previous visits. Majority of the respondents (93.3%) do
have positive or favorable attitude towards CBHI scheme and its role in promoting health
condition of the community. Furthermore, CBHI enable health care providers to prescribe the
appropriate diagnostic test and drugs without any uncertainties about the ability of the CBHI
member to pay. However, work load increases without increasing incentives; that resulted effect
on moral hazards and mistreatment of members. This study has a significant role in filling
research gaps, policy implication and sources of information within the limited literature on the
issue at hand
Description
Keywords
CBHI Scheme; Rural; Household; Health care Seeking Behavior; mixed approach