The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis
Background Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal hea...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Global Health Action |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/16549716.2023.2189764 |
| _version_ | 1797351927244128256 |
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| author | Ewunetie Mekashaw Bayked Husien Nurahmed Toleha Seble Zewdu Kebede Birhanu Demeke Workneh Mesfin Haile Kahissay |
| author_facet | Ewunetie Mekashaw Bayked Husien Nurahmed Toleha Seble Zewdu Kebede Birhanu Demeke Workneh Mesfin Haile Kahissay |
| author_sort | Ewunetie Mekashaw Bayked |
| collection | DOAJ |
| description | Background Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. Objective We evaluated the impact of Ethiopia’s community-based health insurance (2012–2021) on universal health coverage. Methods On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. Results The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44–2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29–2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27–19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12–16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50–1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41–1.02). Conclusion Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population. |
| first_indexed | 2024-03-08T13:07:43Z |
| format | Article |
| id | doaj.art-dc6327400f9543328734ba4a7636a903 |
| institution | Directory Open Access Journal |
| issn | 1654-9880 |
| language | English |
| last_indexed | 2024-03-08T13:07:43Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj.art-dc6327400f9543328734ba4a7636a9032024-01-18T15:58:24ZengTaylor & Francis GroupGlobal Health Action1654-98802023-12-0116110.1080/16549716.2023.21897642189764The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysisEwunetie Mekashaw Bayked0Husien Nurahmed Toleha1Seble Zewdu Kebede2Birhanu Demeke Workneh3Mesfin Haile Kahissay4Wollo UniversityWollo UniversityDessie College of Health Sciences (DCHS)Wollo UniversityAddis Ababa UniversityBackground Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. Objective We evaluated the impact of Ethiopia’s community-based health insurance (2012–2021) on universal health coverage. Methods On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. Results The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44–2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29–2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27–19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12–16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50–1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41–1.02). Conclusion Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.http://dx.doi.org/10.1080/16549716.2023.2189764financial risk protectionhealth-related quality of lifehealthcare seeking behaviorhealth service qualitypopulation coverage |
| spellingShingle | Ewunetie Mekashaw Bayked Husien Nurahmed Toleha Seble Zewdu Kebede Birhanu Demeke Workneh Mesfin Haile Kahissay The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis Global Health Action financial risk protection health-related quality of life healthcare seeking behavior health service quality population coverage |
| title | The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis |
| title_full | The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis |
| title_fullStr | The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis |
| title_full_unstemmed | The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis |
| title_short | The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis |
| title_sort | impact of community based health insurance on universal health coverage in ethiopia a systematic review and meta analysis |
| topic | financial risk protection health-related quality of life healthcare seeking behavior health service quality population coverage |
| url | http://dx.doi.org/10.1080/16549716.2023.2189764 |
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