Tadesse Melkamu Workie, Gebremichael Ayenew Hailu, Sendekie Fentahun Baylie
School of Economics, College of Business and Economics, University of Gondar, Gondar, Ethiopia.
Department of Sociology, School of Sociology and Social Work, College of Social Sciences and the Humanities, University of Gondar, Gondar, Ethiopia.
Health Res Policy Syst. 2025 Mar 31;23(1):39. doi: 10.1186/s12961-025-01294-z.
Healthcare insurance is one of the strategies to achieving universal health coverage and reduce health care inequality among rich and poor households. In line with this goal, the Ethiopian government launched a community-based health insurance program in 2011 to protect rural households and informal workers from catastrophic out-of-pocket medical expenditure that would increase health service quality. However, there is a dearth of evidence on the effect of this program on socio-economic spheres of the community in the study area. This study aims to assess the socio-economic impacts of community-based health insurance through a case study in Gondar Zuria district of Central Gondar Zone, north-west Ethiopia.
A concurrent mixed-methods approach was applied, combining a comparative cross-sectional study design for the quantitative section and descriptive analysis for the qualitative part. The quantitative analysis included responses from 407 households, while the qualitative analysis was based on ten in-depth interviews and three key informant interviews (KIIs). Systematic and maximum variation sampling techniques are used to determine the sample sizes of the datasets, respectively. The quantitative data is generated from the responses of households to structured closed-ended questionnaire by trained data collectors. In-depth interviews and key informant interviews are conducted by the authors with tape-recorder to gather the qualitative data. The quantitative data is analysed by propensity score matching method using STATA-14 software. Findings from the qualitative data are generated through descriptive analysis.
A quantifiable positive association was found between community-based health insurance (CBHI) and welfare on the basis of quantitative data analysis. The results show that insured households have 17% and 20% lower probabilities of experiencing catastrophic health expenditure and labour absenteeism in the workplace, respectively, compared with non-insured households. Insured households are also more likely to have better vertical social capital compared with non-insured households.
Thus, the study concludes that community-based health insurance improves both economic and social status of insured households in the study area, and hence, the program should be scaled-up to include more non-beneficiaries to improve welfare in Ethiopia.
医疗保险是实现全民健康覆盖以及减少贫富家庭之间医疗保健不平等的策略之一。为实现这一目标，埃塞俄比亚政府于2011年启动了一项基于社区的医疗保险计划，以保护农村家庭和非正规就业者免受灾难性自付医疗费用的影响，并提高医疗服务质量。然而，关于该计划对研究区域内社区社会经济领域影响的证据却很匮乏。本研究旨在通过对埃塞俄比亚西北部贡德尔中区贡德尔祖里亚区的案例研究，评估基于社区的医疗保险的社会经济影响。
采用同步混合方法，定量部分采用比较横断面研究设计，定性部分采用描述性分析。定量分析纳入了407户家庭的回复，而定性分析基于10次深入访谈和3次关键信息人访谈（KIIs）。分别使用系统抽样和最大变异抽样技术来确定数据集的样本量。定量数据由经过培训的数据收集员根据家庭对结构化封闭式问卷的回复生成。作者通过录音机进行深入访谈和关键信息人访谈以收集定性数据。使用STATA - 14软件通过倾向得分匹配法对定量数据进行分析。定性数据的结果通过描述性分析得出。
基于定量数据分析发现，基于社区的医疗保险（CBHI）与福利之间存在可量化的正相关关系。结果表明，与未参保家庭相比，参保家庭发生灾难性医疗支出和工作场所旷工的概率分别低17%和20%。与未参保家庭相比，参保家庭也更有可能拥有更好的纵向社会资本。
因此，该研究得出结论，基于社区的医疗保险改善了研究区域内参保家庭的经济和社会地位，因此，该计划应扩大规模，纳入更多非受益人群，以改善埃塞俄比亚的福利状况。
