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1.
Ann Glob Health ; 89(1): 84, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38046537

RESUMO

Background: After years of planning, in 2024 the government of Ethiopia proposes to introduce a compulsory Social Health Insurance (SHI) program for formal sector employees. The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. Objectives: Several studies have examined the willingness to pay (WTP) this premium, however, little is known about the healthcare seeking behavior (HSB) of formal sector employees. This paper investigates both - the determinants of healthcare seeking behavior and among other aspects, WTP the premium. Through these explorations, the paper sheds light on the potential challenges for implementation of SHI. Methods: Descriptive statistics, logit, and multinomial logit (MNL) models are used to analyze retrospective survey data (2,749 formal sector employees) which covers the major regions of the country. Findings: Regarding outpatient care, a majority of the visits (55.9%) were to private healthcare providers. In the case of inpatient care, it was the opposite with a majority of healthcare seekers visiting public sector hospitals (62.5%). A majority of the sample (67%) supported the introduction of SHI but only 24% were willing to pay the proposed SHI premium. The average WTP was 1.6% of gross monthly income. Respondents in the two richest income quintiles were more likely to oppose SHI and consider it unfair. Conclusion: The prominent role of the private sector and the resistance to SHI amongst the two richest income quintiles, suggests that the SHI program needs to actively include private healthcare facilities within its ambit. Additionally, concerted efforts at enhancing the quality of care available at public health facilities, both, in terms of perception and patient-centered care and addressing drug and equipment availability bottlenecks, are needed, if SHI is to garner wider support.


Assuntos
Seguro Saúde , Previdência Social , Humanos , Etiópia , Estudos Retrospectivos , Atenção à Saúde
2.
PLoS One ; 17(3): e0264633, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35239711

RESUMO

BACKGROUND: In low-income countries, vaccination campaigns are lagging, and evidence on vaccine acceptance, a crucial public health planning input, remains scant. This is the first study that reports willingness to take COVID-19 vaccines and its socio-demographic correlates in Ethiopia, Africa's second most populous country. METHODS: The analysis is based on a nationally representative survey data of 2,317 households conducted in the informal economy in November 2020. It employs two logistic regression models where the two outcome variables are (i) a household head's willingness to take a COVID-19 vaccine or not, and (ii) if yes if they would also hypothetically pay (an unspecified amount) for it or not. Predictors include age, gender, education, marital status, income category, health insurance coverage, sickness due to COVID-19, chronic illness, trust in government, prior participation in voluntary activities, urban residence. RESULTS: Willingness to take the vaccine was high (88%) and significantly associated with COVID-19 cases in the family, trust in government and pro-social behavior. All other predictors such as gender, education, income, health insurance, chronic illness, urban residence did not significantly predict vaccine willingness at the 5% level. Among those willing to take the vaccine, 33% also answered that they would hypothetically pay (an unspecified amount) for it, an answer that is significantly associated with trust in government, health insurance coverage and income. CONCLUSION: The results highlight both opportunities and challenges. There is little evidence of vaccine hesitancy in Ethiopia among household heads operating in the informal economy. The role played by trust in government and pro-social behavior in motivating this outcome suggests that policy makers need to consider these factors in the planning of COVID-19 vaccine campaigns in order to foster vaccine uptake. At the same time, as the willingness to hypothetically pay for a COVID-19 vaccine seems to be small, fairly-priced vaccines along with financial support are also needed to ensure further uptake of COVID-19 vaccines.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Recusa de Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Programas de Imunização , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Pobreza , SARS-CoV-2/imunologia , Vacinação , Hesitação Vacinal/psicologia , Hesitação Vacinal/estatística & dados numéricos , Recusa de Vacinação/psicologia , Adulto Jovem
3.
BMJ Open ; 12(2): e056745, 2022 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-35197352

RESUMO

OBJECTIVES: In recent years, Ethiopia has made enormous strides in enhancing access to healthcare, especially, maternal and child healthcare. With the onset and spread of COVID-19, the attention of the healthcare system has pivoted to handling the disease, potentially at the cost of other healthcare needs. This paper explores whether this shift has come at the cost of non-Covid related healthcare, especially the use of maternal and child health (MCH) services. SETTING: Data covering a 24-month period are drawn from 59 health centres and 29 public hospitals located in urban Ethiopia. PRIMARY AND SECONDARY OUTCOMES MEASURES: The primary outcome measures are the use of MCH services including family planning, antenatal and postnatal care, abortion care, delivery and immunisation. The secondary outcome measures are the use of health services by adults including antiretroviral therapy (ART), tuberculosis (TB) and leprosy and dental services RESULTS: There is a sharp reduction in the use of both inpatient (20%-27%, p<0.001) and outpatient (27%-34%, p<0.001) care, particularly in Addis Ababa, which has been most acutely affected by the virus. This decline does not come at the cost of MCH services. The use of several MCH components (skilled birth attendant deliveries, immunisation, postnatal care) remains unaffected throughout the period while others (family planning services, antenatal care) experience a decline (8%-17%) in the immediate aftermath but recover soon after. CONCLUSION: Concerns about the crowding out of MCH services due to the focus on COVID-19 are unfounded. Proactive measures taken by the government and healthcare facilities to ring-fence the use of essential healthcare services have mitigated service disruptions. The results underline the resilience and agility displayed by one of the world's most resource-constrained healthcare systems. Further research on the approaches used to mitigate disruptions is needed.


Assuntos
COVID-19 , Serviços de Saúde Materna , Adulto , Criança , Atenção à Saúde , Etiópia/epidemiologia , Feminino , Instalações de Saúde , Humanos , Pandemias , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , SARS-CoV-2
4.
Health Syst Reform ; 7(2): e1885577, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34402387

RESUMO

We use three years of household panel data to analyze the effects of ill-health on household economic outcomes in rural Ethiopia. We examine the immediate effects of various ill-health measures on health expenditure and labor supply, the subsequent coping responses, and finally the effect on income and consumption. We find evidence of substantial economic risk in terms of increased health expenditure and reduced agricultural productivity. Households are able to smooth consumption by resorting to intra-household labor substitution, borrowing and depleting assets. However, maintaining current consumption through borrowing and depletion of assets is unlikely to be sustainable and displays the need for health financing reforms and safety nets that reduce the financial consequences of ill-health.


Assuntos
Gastos em Saúde , Pobreza , Etiópia , Características da Família , Humanos , População Rural
5.
Artigo em Inglês | MEDLINE | ID: mdl-33218111

RESUMO

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.


Assuntos
Seguro de Saúde Baseado na Comunidade , Qualidade da Assistência à Saúde , Seguro de Saúde Baseado na Comunidade/economia , Seguro de Saúde Baseado na Comunidade/normas , Etiópia , Feminino , Gastos em Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Satisfação do Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos
7.
Soc Sci Med ; 220: 112-119, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30419495

RESUMO

In June 2011, the Government of Ethiopia introduced a pilot Community Based Health Insurance (CBHI) scheme in rural parts of the country. Based on a fixed effects analysis of household panel data, this paper assesses the impact of the scheme on utilization of modern healthcare and the cost of accessing healthcare. It adds to the relatively small body of work that provides a rigorous evaluation of CBHI schemes. We find that in the case of public health facilities, enrolment leads to a 30-41% increase in utilization of outpatient care, a 45-64% increase in the frequency of visits and at least a 56% decline in the cost per visit. The impact on utilization and costs combined with a high uptake rate of almost 50% within two years of scheme establishment underlines the relative success of the Ethiopian scheme. While there are several reasons for this success, a comparative analysis of the design and execution of the Ethiopia CBHI with the existing body of work yields two distinct features. First, the Ethiopian scheme is embedded within existing government administrative structures and to signal government commitment, scheme performance and uptake is used as a yardstick to measure the success of the administration. Second, an existing social protection scheme was used to spread information, raise scheme awareness and encourage uptake of health insurance. The alignment of the interests of administrators with scheme performance and interlinking of social protection schemes are innovative design features that are worth considering as developing countries strive to enhance access to health care through voluntary insurance schemes.


Assuntos
Seguro de Saúde Baseado na Comunidade/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Seguro de Saúde Baseado na Comunidade/tendências , Países em Desenvolvimento , Etiópia , Características da Família , Acessibilidade aos Serviços de Saúde , Humanos , População Rural
8.
Data Brief ; 17: 1388-1390, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29556522

RESUMO

The data presented in this article are related to the research paper titled, "The impact of a household biogas programme on energy use and expenditure in East Java" (A.S. Bedi, R. Sparrow, L. Tasciotti, 2017) [1]. This Data in Brief article presents two rounds of survey data conducted in 2011 and 2012 for a panel of 677 dairy farm households in the province of East Java, Indonesia. The survey relied on structured questionnaires to collect data on the production and use of biogas, the use of other non-renewable energy sources, farm characteristics, and socioeconomic and demographic characteristics of households. The panel data set in STATA format and do files are made publicly available to promote replicability and extended analyses of a sustainable energy initiative.

9.
Soc Sci Med ; 172: 46-55, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27886527

RESUMO

As more and more countries are moving towards Universal Health Coverage (UHC), it is important to understand the macro level or aggregate impacts of such a policy. We use synthetic control methods to study the impact of UHC, introduced in Thailand in 2001, on various macroeconomic and health outcomes. Thailand is compared to a weighted average of control countries in terms of aggregate health financing indicators, aggregate health outcomes and economic performance, over the period 1995 to 2012. Our results suggest that UHC helps alleviate the financial consequences of illnesses. The estimated treatment effect of UHC on out-of-pocket payments as a percentage of overall health expenditures is negative 13 percentage points and its effect on annual government per capita health spending is US$ 79. We detect a smaller effect of US$ 60.8 on total health spending per capita which appears with a lag. We document positive health effects as captured by reductions in infant and child mortality. We do not find any effect on GDP and the share of the government budget devoted to health. Overall, our results complement micro evidence based on within country variation. The counterfactual design implemented here may be used to inform other countries on the macro level repercussions of UHC.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Financiamento da Assistência à Saúde , Avaliação de Resultados em Cuidados de Saúde , Cobertura Universal do Seguro de Saúde/economia , Análise Custo-Benefício , Humanos , Tailândia , Cobertura Universal do Seguro de Saúde/normas , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Organização Mundial da Saúde/organização & administração
10.
Health Policy Plan ; 32(1): 91-101, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27497140

RESUMO

Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features.


Assuntos
Programas Governamentais/estatística & dados numéricos , Reforma dos Serviços de Saúde/economia , Financiamento da Assistência à Saúde , Assistência ao Paciente/economia , Programas Governamentais/organização & administração , Humanos , Indonésia , Programas Nacionais de Saúde/economia , Assistência ao Paciente/estatística & dados numéricos , Inquéritos e Questionários
11.
Soc Sci Med ; 176: 133-141, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28135692

RESUMO

Due to lack of well-developed insurance and credit markets, rural families in Ethiopia are exposed to a range of covariate and idiosyncratic risks. In 2005, to deal with the consequences of covariate risks, the government implemented the Productive Safety Net Program (PSNP), and in 2011, to mitigate the financial consequences of ill-health, the government introduced a pilot Community Based Health Insurance (CBHI) Scheme. This paper explores whether scheme uptake and retention is affected by access to the PSNP. Based on household panel data and qualitative information, the analysis shows that participating in the PSNP increases the probability of CBHI uptake by 24 percentage points and enhances scheme retention by 10 percentage points. A large proportion of this effect may be attributed to explicit and implicit pressure applied by government officials on PSNP beneficiaries. Whether this is a desirable approach is debatable. Nevertheless, the results suggest that membership in existing social protection programs may be leveraged to spread new schemes and potentially accelerate poverty reduction efforts.


Assuntos
Seguro Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Participação da Comunidade/estatística & dados numéricos , Etiópia , Programas Governamentais/normas , Programas Governamentais/estatística & dados numéricos , Reforma dos Serviços de Saúde/métodos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários
12.
Health Policy Plan ; 31(10): 1433-1444, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27476500

RESUMO

Low renewal rate is a key challenge facing the sustainability of community-based health insurance (CBHI) schemes. While there is a large literature on initial enrolment into such schemes, there is limited evidence on the factors that impede renewal. This article uses longitudinal data to analyse what determines renewal, both 1 year and 2 years after the introduction of three CBHI schemes, which have been operating in rural Bihar and Uttar Pradesh since 2011. We find that initial scheme uptake is ∼23-24% and that 2 years after scheme operation, only ∼20% of the initial enrolees maintain their membership. A household's socio-economic status does not seem to play a large role in impeding renewal. In some instances, a greater understanding of the scheme boosts renewal. The link between health status and use of health care in maintaining renewal is mixed. The clearest effect is that individuals living in households that have received benefits from the scheme are substantially more likely to renew their contracts. We conclude that the low retention rates may be attributed to limited benefit packages, slow claims processing times and the gap between the amounts claimed and amounts paid out by insurance.


Assuntos
Participação da Comunidade , Financiamento Pessoal/economia , Nível de Saúde , Seguro Saúde/economia , Características da Família , Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Humanos , Índia , Estudos Longitudinais , População Rural , Fatores Socioeconômicos
14.
Health Policy Plan ; 30(10): 1296-306, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25616670

RESUMO

Low contract renewal rates have been identified as one of the challenges facing the development of community-based health insurance (CBHI) schemes. This article uses longitudinal household survey data gathered in 2012 and 2013 to examine dropout in the case of Ethiopia's pilot CBHI scheme. We treat dropout as a function of scheme affordability, health status, scheme understanding and quality of care. The scheme saw enrolment increase from 41% 1 year after inception to 48% a year later. An impressive 82% of those who enrolled in the first year renewed their subscriptions, while 25% who had not enrolled joined the scheme. The analysis shows that socioeconomic status, a greater understanding of health insurance and experience with and knowledge of the CBHI scheme are associated with lower dropout rates. While there are concerns about the quality of care and the treatment meted out to the insured by providers, the overall picture is that returns from the scheme are overwhelmingly positive. For the bulk of households, premiums do not seem to be onerous, basic understanding of health insurance is high and almost all those who are currently enrolled signalled their desire to renew contracts.


Assuntos
Participação da Comunidade , Seguro Saúde/estatística & dados numéricos , Etiópia , Características da Família , Acessibilidade aos Serviços de Saúde , Humanos , Seguro Saúde/economia , Estudos Longitudinais , Satisfação Pessoal , Classe Social , Fatores Socioeconômicos , Inquéritos e Questionários
15.
Health Policy Plan ; 29(8): 960-74, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24162838

RESUMO

This article assesses insurance uptake in three community-based health insurance (CBHI) schemes located in rural parts of two of India's poorest states and offered through women's self-help groups (SHGs). We examine what drives uptake, the degree of inclusive practices of the schemes and the influence of health status on enrolment. The most important finding is that a household's socio-economic status does not appear to substantially inhibit uptake. In some cases scheduled caste/scheduled tribe households are more likely to enrol. Second, households with greater financial liabilities find insurance more attractive. Third, access to the national hospital insurance scheme Rashtriya Swasthya Bima Yojana does not dampen CBHI uptake, suggesting that the potential for greater development of insurance markets and products beyond existing ones would respond to a need. Fourth, recent episodes of illness and self-assessed health status do not influence uptake. Fifth, insurance coverage is prioritized within households, with the household head, the spouse of the household head and both male and female children of the household head, more likely to be insured as compared with other relatives. Sixth, offering insurance through women's SHGs appears to mitigate concerns about the inclusiveness and sustainability of CBHI schemes. Given the pan-Indian spread of SHGs, offering insurance through such groups offers the potential to scale-up CBHI.


Assuntos
Participação da Comunidade , Seguro Saúde , Características da Família , Feminino , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Nível de Saúde , Humanos , Índia , Masculino , População Rural , Grupos de Autoajuda , Fatores Socioeconômicos
16.
BMJ Open ; 4(2): e004020, 2014 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-24525391

RESUMO

OBJECTIVES: To investigate the determinants of healthcare-seeking behaviour using five context-relevant clinical vignettes. The analysis deals with three issues: whether and where to seek modern care and when to seek care. SETTING: This study is set in 96 villages located in four main regions of Ethiopia. The participants of this study are 1632 rural households comprising 9455 individuals. PRIMARY AND SECONDARY OUTCOME MEASURES: Probability of seeking modern care for symptoms related to acute respiratory infections/pneumonia, diarrhoea, malaria, tetanus and tuberculosis. Conditional on choosing modern healthcare, where to seek care (health post, health centre, clinic and hospital). Conditional on choosing modern healthcare, when to seek care (seek care immediately, the next day, after 2 days, between 3 days to 1 week, a week or more). RESULTS: We find almost universal preference for modern care. Foregone care ranges from 0.6% for diarrhoea to 2.5% for tetanus. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centres, private/Non-Government Organization (NGO) clinics as opposed to health posts. Delays in care-seeking behaviour are apparent mainly for adult-related conditions and among poorer households. CONCLUSIONS: The analysis suggests that the lack of healthcare utilisation is not driven by the inability to recognise health problems or due to a low perceived need for modern care.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , População Rural , Adulto , Criança , Etiópia , Feminino , Humanos , Masculino , Preferência do Paciente , Classe Social
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