Effectiveness of Community-Based Health Insurance in Ethiopia: Challenges and Prospects

Abstract

Access to healthcare services is an essential for maintaining and improving health of citizen. Good health is a key to sustained economic, social development and poverty reduction. In developing countries, Community Based Health Insurance schemes (CBHI) are expected as a transitional mechanism to achieving the goals of Universal Healthcare Coverage program; i.e. all people should have equitable access to health services, improved quality of health services, and financial-risk protection. CBHI program is a form of financing healthcare for poor and rural people based on risk- pooling approach that spread healthcare expenditures across community (member households) with different health profiles. The schemes are built upon the principles of social solidarity and common benefits to provide financial protection against medical expenses. This study aims to analyze the effectiveness of community-based health insurance in Ethiopia from Universal Healthcare Coverage goals perspective. The study employed a qualitative research design by relies on secondary sources which were collected from credible and reliable online sources, i.e. published articles and newspapers. The study shows that the schemes are successful on some of effectiveness indicator variables; such as financial risk protection and improved utilization of health services, whereas the schemes are ineffective and unsuccessful on the variables/indicators like enrolment rate, revenue mobilization, equitable access to healthcare services, and improves healthcare services. The study also reveals that the major challenges that limits the effectiveness of the schemes are; adverse selection due to voluntary membership to the scheme, limited risk pool which is created due to limited enrolment and some dropout, poor financial risk protection due to low risk pooling and revenue collection, lack of quality service that discouraging people to joining the scheme and limits them from renewal of membership, and lack of professional and standardized management that comes from lack of skilled manpower and low commitments from the stakeholders.