Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
PLoS One. 2022 Aug 29;17(8):e0266583. doi: 10.1371/journal.pone.0266583. eCollection 2022.
The term "community-based health insurance" refers to a broad range of nonprofit, prepaid health financing models designed to meet the health financing needs of disadvantaged populations, particularly those in the rural and informal sectors. Due to their voluntary nature, such initiatives suffer from persistently low coverage in low- and middle-income countries. In Ethiopia, the schemes' membership growth has not been well investigated so far. This study sought to examine the scheme's enrollment trend over a five-year period, and to explore the various challenges that underpin membership growth from the perspectives of various key stakeholders.
The study employed a mixed methods case study in two purposively selected districts of northeast Ethiopia: Tehulederie and Kallu. By reviewing the databases of health insurance schemes, quantitative data were collected retrospectively from 2017 to 2021 to examine enrollment trends. Trends for each performance indicator were analyzed descriptively for the period under study. Face-to-face interviews were conducted with nine community members and 19 key informants. Study participants were purposely selected using the maximum variation technique. Interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was employed with both deductive and inductive coding approaches.
Over the course of the study period, enrollment in the scheme at both districts exhibited non-linear trends with both positive and negative growth rates being identified. Overall, the scheme in Tehulederie has a relatively higher population coverage and better membership retention, which could be due to the strong foundation laid by a rigorous public awareness campaign and technical support during the pilot phase. The challenges contributing to the observed level of performance have been summarized under four main themes that include quality of health care, claims reimbursement for insurance holders, governance practices, and community awareness and acceptability.
The scheme experienced negative growth ratios in both districts, indicating that it is not functionally viable. It will fail to meet its mission unless relevant stakeholders at all levels of government demonstrate political will and commitment to its implementation, as well as advocate for the community. Interventions should target on the highlighted challenges in order to boost membership growth and ensure the scheme's viability.
“社区健康保险”一词是指广泛的非营利性、预付款健康融资模式，旨在满足弱势人群的健康融资需求，特别是农村和非正规部门的人群。由于其自愿性质，此类举措在中低收入国家的覆盖面一直很低。在埃塞俄比亚，这些计划的参保人数增长尚未得到很好的调查。本研究旨在考察五年期间该计划的参保趋势，并从各种利益攸关方的角度探讨支撑参保人数增长的各种挑战。
本研究在埃塞俄比亚东北部两个有针对性选择的地区——特胡莱德雷和卡卢采用了混合方法案例研究。通过审查健康保险计划的数据库，从 2017 年到 2021 年，我们回顾性地收集了定量数据，以考察参保趋势。对研究期间的每个绩效指标进行描述性分析。对 9 名社区成员和 19 名关键信息提供者进行了面对面访谈。使用最大变异技术有针对性地选择研究参与者。访谈进行了录音、逐字记录，并翻译成英文。采用演绎和归纳编码方法进行主题分析。
在研究期间，两个地区的参保人数呈非线性趋势，既有正增长，也有负增长。总体而言，特胡莱德雷的计划相对具有更高的人口覆盖率和更好的参保保留率，这可能是由于在试点阶段进行了严格的公众意识宣传活动和技术支持，奠定了坚实的基础。导致观察到的绩效水平的挑战总结在四个主要主题下，包括医疗保健质量、保险持有人的报销索赔、治理实践以及社区意识和可接受性。
两个地区的计划都出现了负增长，表明其无法正常运行。除非各级政府的相关利益攸关方表现出对其实施的政治意愿和承诺，并倡导社区，否则该计划将无法实现其使命。干预措施应针对突出的挑战，以促进参保人数的增长并确保计划的可行性。
