Challenges of Community-Based Health Insurance in Ethiopia

Many people in developing countries struggle with high health care costs. These costs can make it hard for families to get the medical help they need. A large number of people, around 800 million, spend at least 10% of their income on health care. For nearly 100 million of them, this spending can push them into extreme poverty, forcing them to live on just $1.90 or less a day.

To help people access health services without worrying about costs, Community-Based Health Insurance (CBHI) schemes have been set up since the late 1800s in some developing countries. CBHI aims to help reduce health care costs for families and improve health care access. These schemes are community-focused, allowing local involvement in managing the insurance plans. Membership fees are generally low, and a big part of the health care expenses is often covered by the government. CBHI is different from other health insurance programs that mostly serve working individuals or those funded by taxes.

#Evaluating CBHI

Many studies have looked at how effective CBHI is in helping people get medical care and how it impacts out-of-pocket spending. While it appears promising in improving health care access, there are worries about how long it can keep working as a way to fund health care. In Tanzania, for example, researchers found that large health care claims are a concern. They suggested that policymakers might need to cut back on health benefits or find more money to keep the insurance going. Similar issues have been reported in Ethiopia, where excessive claims have led to financial trouble for some CBHI programs.

Large claims can come from different reasons, one being how people behave after they join an insurance plan. Once insured, some people may overuse health services, especially if they have serious health issues. This could be because they feel less financial pressure to seek care. Another issue is that some might not follow preventive health practices, which can lead to future health problems and larger claims.

While there isn't much evidence showing whether behaving poorly leads to higher health care costs in CBHI schemes, studies in different types of insurance suggest mixed results. In wealthier countries, insurance might encourage some to take on unhealthy habits because the costs of their health issues are shared. However, other research shows insured individuals often seek Preventive Care, indicating insurance might encourage healthier behaviors.

#Behavioral Responses to Insurance in Low-Income Settings

Some studies have tried to look into how people behave differently with insurance in poorer settings. One study in Burkina Faso examined whether having CBHI made people more likely to seek medical help when they were sick. Other studies looked at how insurance influences preventive measures, such as using malaria prevention methods.

This article will focus on how Ethiopian CBHI affects behaviors related to preventive care, like washing hands before meals and treating drinking water. We will also analyze how quickly people seek medical help for symptoms of illnesses such as Malaria, Tetanus, and Tuberculosis. Unlike other studies that mostly focused on what treatments people choose, we will look at when families decide to get care for symptoms. This is important because waiting too long to seek medical help can raise costs and impact the insurance program’s long-term ability to function.

CBHI has been active in Ethiopia since 2011, covering both rural and urban people working in the informal sector. The scheme aims to help low-income families afford healthcare, thus improving their overall health. It initially started in four regions and has since expanded to cover many more areas.

By mid-2022, over 879 districts had joined CBHI, with more than 40% of the population participating. The goal is to reach 80% coverage in the future, helping as many families as possible.

#Research Methodology

Using data collected from households over three years, we applied a method to see how CBHI affects behaviors and healthcare-seeking patterns. Our findings revealed that joining CBHI did not significantly change preventive care behaviors, but it was linked to delays in getting medical help.

#Understanding CBHI in Ethiopia

Ethiopia is divided into various regions, and before 2011, many people had to pay for health care out of pocket, which stopped many from getting the care they needed. Since introducing CBHI, many families in the informal sector can access health care at a lower cost. The scheme was initially tested in selected districts from four main regions, and it has since expanded.

The CBHI program has a fixed premium, meaning everyone pays the same amount, which makes it affordable. The yearly cost for households used to be low but has since increased. The cost represents a small percentage of household income, varying slightly by region. Households pay a one-time registration fee and ongoing premiums to their local office, which funds the CBHI scheme. The program also helps the very poor with fee waivers, although few eligible households take advantage of this.

The benefits from CBHI cover hospital and outpatient care, but not transport costs to facilities. Patients want to receive treatment in urban hospitals, but they must first go through the right channels. Under CBHI, there’s no extra charge for more services, but treatments at private health facilities are generally not covered unless they are not available at public ones.

In our study, we looked at data across several years, comparing CBHI-insured households with those that were not. We found out that the insured households appeared to be further away from health facilities, and they had better access to clean water and lighting.

#Changes in Health Behaviors

Through our analysis, we observed the average health-seeking behaviors of both insured and uninsured households over the years. There was a slight increase in hand-washing among insured households, while the rate decreased for uninsured ones. The pattern for treating water showed a V-shape for the insured, but a downward trend for the uninsured.

We also noticed that the insured households showed increased waiting times for seeking treatment for malaria, tetanus, and tuberculosis. Instead of getting medical attention right away, they tended to wait more, possibly due to a false sense of security from having insurance.

#Conclusion

Overall, while CBHI does not seem to promote preventive health behaviors, it does appear to contribute to delays in healthcare access. This delay can lead to more severe health problems and higher health care costs in the long run. It can also pose significant challenges for the future of CBHI.

The findings highlight the need to understand and address the factors causing delays in seeking medical care among insured members. Ensuring timely access to healthcare is vital for the survival of Ethiopian CBHI.

The expansion of CBHI, along with investments in health infrastructure, can help prevent these behavioral issues. Improving the quality of care and reducing waiting times could encourage quicker visits for medical services.

Though there are limitations in our data, exploring different factors that contribute to challenges faced by CBHI will be essential for advancing access to care in developing countries. This understanding will play a crucial role in working toward universal health coverage and improving the overall health of communities.