Atnafu Asmamaw, Gebremedhin Tsegaye
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Clinicoecon Outcomes Res. 2020 Aug 10;12:435-444. doi: 10.2147/CEOR.S262225. eCollection 2020.
Utilization of primary healthcare services in the rural communities of Ethiopia is very low. The Ethiopian government has introduced community-based health insurance (CBHI) to improve the health service utilization of the rural community. Thus, this study was conducted to examine the association between CBHI enrollment and child health service utilization in northwest Ethiopia.
A cross-sectional case comparison study among CBHI enrolled and unenrolled households was conducted. A total of 226 sick children from 2008 surveyed households were included in the study. Bivariate-probit regression analysis was employed to account the endogenous nature of insurance enrollment and child health services utilization.
The results showed that the overall sick child healthcare visit in the CBHI enrolled group was about 0.44 (44%) point more compared to those unenrolled households. CBHI enrolled households in the poorest wealth group have a higher probability of visiting healthcare facilities for their sick children (coefficient: 0.13, SD: 0.07, 95% CI: -0.01, 0.27), whereas CBHI enrolled households with older age household head have a lower probability of visiting healthcare facilities for their sick children (coefficient: -0.16, SD: 0.08, 95% CI: -0.32, 0.01).
A promising positive effect on sick children's health services utilization among CBHI enrolled was noticed. Moreover, households in the poorest wealth status and older age head affect the use of sick children's healthcare services among those CBHI enrolled. Therefore, policy measures to expand benefit packages and supply-side interventions are essential to enhance the effects of CBHI on different health service utilization.
埃塞俄比亚农村社区对初级医疗服务的利用率非常低。埃塞俄比亚政府推出了基于社区的医疗保险（CBHI），以提高农村社区的医疗服务利用率。因此，本研究旨在探讨埃塞俄比亚西北部CBHI参保情况与儿童医疗服务利用率之间的关联。
对参保和未参保家庭进行了一项横断面病例对照研究。研究共纳入了2008户家庭中的226名患病儿童。采用双变量概率单位回归分析来考虑保险参保和儿童医疗服务利用的内生性质。
结果显示，与未参保家庭相比，CBHI参保组患病儿童的总体医疗就诊率高出约0.44（44%）个百分点。最贫困财富组中参保CBHI的家庭为患病儿童前往医疗机构就诊的可能性更高（系数：0.13，标准差：0.07，95%置信区间：-0.01，0.27），而户主年龄较大的参保CBHI家庭为患病儿童前往医疗机构就诊的可能性较低（系数：-0.16，标准差：0.08，95%置信区间：-0.32，0.01）。
注意到CBHI参保对患病儿童医疗服务利用有显著的积极影响。此外，最贫困的财富状况家庭和年龄较大的户主会影响参保CBHI家庭中患病儿童医疗服务的使用。因此，扩大福利套餐的政策措施和供应方干预对于增强CBHI对不同医疗服务利用的影响至关重要。
