Does community-based health insurance affect lifestyle and timing of treatment seeking behavior? Evidence from Ethiopia

Zecharias Fetene Anteneh , Anagaw D. Mebratie , Zemzem Shigute , Getnet Alemu , Arjun S. Bedi
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Abstract

Objectives

This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance (CBHI) scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms. There is growing concern about the financial sustainability of CBHI schemes in developing countries. However, few empirical studies have identified potential contributors, including ex-ante and ex-post moral hazards.

Methods

We implement a household fixed-effect panel data regression model, drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.

Results

The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals. However, CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms. Particularly, on average, we estimate about 4‒6 h delay for malaria symptoms, a little above 4 h for tetanus, and 10‒11 h for tuberculosis among the insured households.

Conclusions

While there is evidence that CBHI improve the utilization of outpatient or primary care services, our study suggests that insured members may wait longer before visiting health facilities. This delay could be partly due to moral hazard problems, as insured households, particularly those from rural areas, may consider the opportunity costs associated with visiting health facilities for minor symptoms. Overall, it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

社区医疗保险会影响生活方式和就医时间吗?埃塞俄比亚的证据
本文旨在研究加入埃塞俄比亚社区医疗保险(CBHI)计划对家庭预防保健活动和疾病症状就医行为时间的影响。人们越来越关注发展中国家社区医疗保险计划在财务上的可持续性。方法我们利用在埃塞俄比亚实施 CBHI 计划的地区和未实施 CBHI 计划的地区面对面收集到的三轮家庭调查数据,建立了一个家庭固定效应面板数据回归模型。结果研究结果表明,参加 CBHI 并不会显著影响家庭的预防性保健活动行为,如饮水前处理和饭前洗手。然而,社区保健倡议明显增加了因疾病症状而延迟就医的行为。结论虽然有证据表明社区医疗保险提高了门诊或初级医疗服务的利用率,但我们的研究表明,参保成员在前往医疗机构就诊前可能会等待更长时间。这种延迟的部分原因可能是道德风险问题,因为投保家庭,尤其是农村地区的投保家庭,可能会考虑因轻微症状而前往医疗机构就诊的机会成本。总之,有必要找出延误就医的主要原因,并采取适当的干预措施,鼓励投保人尽早就医。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Global health journal (Amsterdam, Netherlands)
Global health journal (Amsterdam, Netherlands) Public Health and Health Policy
CiteScore
5.00
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