Department of Nursing, Dessie Health Science College, Dessie, Ethiopia.
PLoS One. 2023 Feb 15;18(2):e0281476. doi: 10.1371/journal.pone.0281476. eCollection 2023.
Every health system needs to take action to shield households from the expense of medical costs. The Ethiopian government implemented community-based health insurance (CBHI) to protect households from catastrophic health care expenditure (CHE) and enhance the utilization of health care services. The impact of CBHI on CHE with total household expenditure and non-food expenditure measures hadn't been studied, so the study aimed to evaluate the impact of CBHI on CHE among households in Kutaber district, Ethiopia.
A total of 472 households (225 insured and 247 uninsured) were selected by multistage sampling techniques. Households total out-of-pocket (OOP) health payments ≥10% threshold of total household expenditure or ≥40% threshold of household non-food expenditure categorized as CHE. The co-variants for participation in the CBHI scheme were estimated by using a probit regression model. A propensity score matching analysis was used to determine the impact of CBHI on CHE. A Chi-square (χ2) test was computed to compare CHE between insured and uninsured households.
The magnitude of CHE was 39.1% with total household expenditure and 1.8% with non-food expenditure measures among insured households. Insured households were 46.3% protected from CHE when compared to uninsured households with total household expenditure measures and 24.2% to 25% with non-food expenditure measures.
The magnitude of CHE was lower among CBHI-enrolled households. CBHI is an effective means of financial protection benefits for households as a share of total household expenditure and non-food expenditure measures. Therefore, increasing the upper limits of benefit packages, minimizing exclusions, and CBHI scale-up to uninsured households is essential.
每个卫生系统都需要采取行动，保护家庭免受医疗费用的负担。埃塞俄比亚政府实施了基于社区的健康保险（CBHI），以保护家庭免受灾难性医疗支出（CHE）的影响，并提高医疗服务的利用。CBHI 对以家庭总支出和非食品支出衡量的 CHE 的影响尚未得到研究，因此本研究旨在评估 CBHI 对埃塞俄比亚库塔贝尔区家庭 CHE 的影响。
采用多阶段抽样技术，共选择了 472 户家庭（225 户参保和 247 户未参保）。家庭总自付（OOP）健康支出占家庭总支出的 10%或占家庭非食品支出的 40%以上，被归类为 CHE。使用概率回归模型估计参与 CBHI 计划的协变量。采用倾向评分匹配分析来确定 CBHI 对 CHE 的影响。采用卡方（χ2）检验比较参保和未参保家庭的 CHE。
参保家庭的 CHE 发生率为 39.1%，以家庭总支出衡量；为 1.8%，以非食品支出衡量。与家庭总支出衡量的未参保家庭相比，参保家庭在 CHE 方面的保护率为 46.3%；以非食品支出衡量，保护率为 24.2%至 25%。
参保家庭的 CHE 发生率较低。CBHI 是家庭在总家庭支出和非食品支出方面获得经济保护的有效手段。因此，增加福利套餐的上限，减少排除，以及扩大 CBHI 参保范围，对未参保家庭来说是必要的。
