Paper long abstract:

Ethiopia’s Community Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure, mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced access to health care and led to reductions in out-of-pocket expenditure. Whether the scheme has also delivered on its other objectives is not known. This paper uses a double-difference approach applied to two rounds of health facility survey data and three rounds of household survey data to examine scheme effects on health facility revenues and on different dimensions of quality of care. We find that CBHI affiliated facilities experience a 111 percent increase in the annual volume of out-patient visits and annual revenues increased by about 47 percent. The increased revenues are used to deal with drug shortages. These increases seem to have translated into increases in patient satisfaction. The satisfaction of patients who sought outpatient health care from CBHI-contracted health centers is 11 percentage points higher as compared to those who received the service from non-contracted health centers. Furthermore, despite the increase in patient volume there is no discernible increase in waiting time to see medical professionals. These results combined with the relatively high levels of CBHI enrolment, 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 voluntary health insurance schemes in Sub-Saharan Africa.

Co-authors: Anagaw Mebratie, Robert Sparrow