Explore the vast range of titles available.

Universal Health Coverage (UHC) has engaged attention of policy makers at both global and country levels. UHC is one of three strategic priorities of World Health Organization's (WHO) general program of work for 2019-2023, and it is then a global health priority. Rwanda Community-Based Health Insurance is considered the vehicle for UHC and Universal Health Insurance in Rwanda. CBHI was officially introduced in 1999/2000 and through 2011/2012 Rwanda was not far from effective UHC. However, since then, CBHI faced chronic financial deficit. This study aims to assess challenges facing Community-Based Health Insurance financial sustainability and to propose indicative solutions. quantitative, qualitative, analytical, longitudinal (2011-2018) and documentary mixed methods were applied. One National Pooling Risk (100%), 15 Community-Based Health Insurance districts (50%) and 60 Community Based Health Insurance sections (13.33%) were randomly selected and included in the study. To assess major challenges, \"analyzing qualitative data G3658-6 approach\" and \"prioritization hanlon method\" were used. the study highlighted five major challenges: (i) disproportionate risk-equalization in the social health insurance contributory system; (ii) unit cost exceeding individual income (premium plus other revenues and subsidies); (iii) imperfection in funding mobilization and recovery; (iv) cost-escalation; (v) diseconomy of scale; and the study proposed indicative solutions including injection of additional funding and shifting from current fee-for-service payment to fully active strategic purchasing mechanisms as accompanying measures. CBHI financial sustainability is achievable, but this is contingent upon persistence of political commitment efforts to achieve UHC, correction of highlighted imperfections and injection of additional funding to allow Rwanda Community-Based Health Insurance to meet and/or exceed its cost in the long-term.

Background Globally, Millions of people cannot use health services because of the fear of payment for the service at the time of service delivery. From the agenda of transformation and the current situation of urbanization as well as to ensure universal health coverage implementing this program to the urban resident is mandatory. The aim of this study is to assess the willingness of community-based health insurance (CBHI) uptake and associated factors among urban residents of Oromia regional state, Oromia, Ethiopia, 2018. Methods A community-based cross-sectional study was conducted. From the total of eighteen towns; six towns which account for 33% of the total were selected randomly for the study. One population proportion formula was employed to get a total of 845 households. A pre-tested, semi-structured interviewer-administered questionnaire was used to collect the required data. Double-Bounded Dichotomous Choice Variant of the contingent valuation method was used to assess the maximum willingness to pay for the scheme, and a multiple logistic regression model was used to determine the effect of various factors on the willingness to join and willingness to pay for the households. Result About 839 (99.3%) of the respondents participated. The mean ages of the respondents were 40.44(SD ± 11.12) years. 621 (74.1%) ever heard about CBHI with 473 (56.3%) knowing the benefits package. Out of 839, 724 (86.3%) were willing to uptake CBHI of which 704 (83.9%) were willing to pay if CBHI established in their town. Conclusion If CBHI established about 86.3% of the households would enroll in the scheme. Having education, with a family size between 3 & 6, having difficulty in paying for health care and less than 20mins it took to reach the nearest health facility were the independent predictors of the willingness of CBHI uptake. The Oromia and Towns Health Bureau should consider the availability of health facilities near to the community and establishing CBHI in the urban towns.

Background Patient satisfaction is a key indicator of health care quality and is often linked to better adherence to medical recommendations and increased utilization of health services. Despite its importance, evidence on satisfaction with community-based health insurance (CBHI) in Addis Ababa is limited. This study aimed to assess the level of satisfaction among CBHI members and identify associated factors at the household level in Addis Ababa, Ethiopia. Methods A community-based cross-sectional study was conducted in Addis Ababa with mixed method. Data was collected on 630 households by using systematic random sampling method. Data was entered into Epi Data, and exported into SPSS version 25 for analysis. A bivariate binary logistic regression statistical analysis was used to identify potential candidate variables (p 0.25). The result was presented using COR and AOR with 95% CI and a p value less than 0.05 was considered significant in multivariate regression. In addition to the quantitative data, focus group discussions and key informant interviews with health professionals, CBHI office staff, and community leaders were conducted until data saturation. Semi-structured guides were used, and thematic analysis was applied. Result The study revealed that the level of satisfaction with the community-based health insurance scheme was found to be 51.6% (46.29–54.01). Marital status/divorced (AOR = 0.18, 95% CI (0.07–0.42)), knowledge of community-based health insurance benefit packages (AOR = 4.49, 95% CI=(2.19–9.21)), received correct prescribed drug (AOR = 4.52, 95% CI= (1.83–15.88)), participated on community-based health insurance related meetings (AOR = 11.04, 95% CI= (5.82–20.91)) and has qualified health professionals (AOR = 3.13, 95% CI=(1.72–5.71)), availability and sanitation of showers and toilets (AOR = 2.25, 95% CI=(1.10–4.63)) and satisfaction with the health facilities included in the CBHI scheme (AOR = 2.31, 95% CI =(1.02–5.23)) were significantly associated with household’s satisfaction to community-based health insurance scheme. Qualitative findings from focus group discussions and key informant interviews revealed several barriers to effective CBHI implementation in Addis Ababa. Major challenges included limited awareness of CBHI services among members and health professionals, lack of compassionate and respectful care, shortages of medications, laboratory, and diagnostic services, and difficulties with premium payment modalities. These factors were consistent with the quantitative findings, highlighting their influence on household satisfaction with the CBHI scheme. Conclusions Around half of households were satisfied with the community-based health insurance (CBHI) scheme. Household satisfaction was significantly associated with marital status, educational level, knowledge of CBHI benefit packages, receipt of correctly prescribed drugs, participation in CBHI-related meetings, presence of qualified health professionals, availability and sanitation of showers and toilets, and satisfaction with the permitted health institutions. Qualitative findings further highlighted barriers to satisfaction, including limited awareness of CBHI services, lack of respectful and compassionate care, shortages of medications, laboratory and diagnostic services, and difficulties with premium payment modalities. To enhance the sustainability of the community-based health insurance scheme, it is recommended to strengthen the supply chain for essential medicines, improve communication and awareness among CBHI members, and enhance the responsiveness and quality of care provided by health professionals.

Background Despite the global target of 80% glycemic control among people diagnosed with diabetes in 2030, diabetes treatment coverage and control rate were still low. Diabetes imposes a substantial economic burden on health systems, patients, and their families. Due to low health insurance coverage in developing countries, the expenses related to diabetes care often result in significant out-of-pocket costs for patients. Objective To assess the level of out–of–pocket expenditure and the effect of community-based health insurance (CBHI) on out-of-pocket (OOP) expenditure among diabetic patients on follow-up at Hawassa Comprehensive Specialized Hospital, Sidama region. Method A facility-based comparative cross-sectional was conducted among 314 randomly selected adult type 2 diabetics. Kobo Collect app and SPSS version 26 were used data collection and analysis respectively. Independent sample t-test and linear regression were used to compare OOP expenses between CBHI members and non-members, and assess the association between CBHI-enrollment and OOP expenses. Result The average monthly household expenditure among participants was 6,471.52 Ethiopian Birr (ETB) (SD ± 3,275.47). Of which, average monthly costs of 3,568.55 ETB for food and 2,902.97 ETB for non-food items. The average monthly expenditure for diabetic illness was 2,046.00 ETB (SD ± 3,173.50), of which 869.67 ETB (42.5%) were direct medical costs. Regarding incidence and severity of catastrophic health expenditure (CHE), 82.5% of patients faced CHE at the 10% threshold, while only 27.4% did so at the 40% threshold. The intensity of OOP was 67 (43.2%), and 120 (75.5%) among CBHI members and non-members, respectively ( p  = 0.000). The CBHI enrollment is significantly associated with a reduction in OOP expenses, with a coefficient of -499.410 ( p  = 0.000). Similarly, age and occupation of participants were associated with lower OOP expenses, with a coefficient of -8.756 ( p  = 0.028) and − 58.221 ( p  = 0.002), respectively. Educational status of participants was associated with higher OOP expenses, with a coefficient of 104.416 ( p  = 0.004). However, marital status, household size, and wealth percentile group did not have a significant effect on OOP expenses among diabetic patients. Conclusion A significant proportion of diabetes patients experienced CHE. Enrollment in CBHI lowered OOP costs and reduced CHE. But there are still gaps in CBHI coverage, especially when it comes to the lowest and middle wealth quantiles. To enhance CBHI effectiveness, it is important to prioritize rural and low-income households to reduce financial strain. Introduce a subsidy program to make diabetes medications more affordable for uninsured households. Incorporate beneficiary feedback to refine policies and address the diverse needs of enrollees. Future research to evaluate the long-term impacts of CBHI on diabetic patient expenses on household financial stability by involving hospitals from rural and urban sectors is important to better understand the effect of CBHI on OOP expense and catastrophic health expenditure in the region.

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Africa.

Community-Based Health Insurance (CBHI) programs are vital in improving healthcare accessibility and providing financial protection, especially in resource-limited settings such as Dangila Wereda, Awi Zone, Ethiopia. This study evaluates the impact of CBHI on health service utilization and out-of-pocket healthcare expenditures while identifying key factors influencing enrollment and assessing program effectiveness. A cross-sectional study was conducted among 419 households. Binary logistic regression was applied to determine factors affecting CBHI enrollment. Likert scale analysis was used to assess household attitudes, and propensity score matching (PSM) was employed to measure the impact of CBHI on healthcare utilization and financial burden reduction. Significant predictors of CBHI enrollment included family size, tropical livestock units, income level, sickness occurrence in the past year, awareness of CBHI, presence of functional health centers in the village, and trust in the CBHI scheme. Household perceptions reflected cautious optimism regarding CBHI’s ability to enhance service quality and alleviate financial burdens. PSM analysis showed an average annual reduction of 1444.60 ETB in healthcare expenditures and a 3.24-fold increase in healthcare utilization among CBHI members. CBHI has a positive impact on reducing healthcare costs and improving utilization in Dangila Wereda. However, addressing concerns about service quality, strengthening awareness campaigns, and enhancing trust in the program are essential to maximizing its effectiveness. Ongoing evaluation and targeted interventions are recommended to sustain and improve CBHI’s impact on healthcare access and financial security.

Background Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. Methods We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. Results Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility bankruptcy, operating on small budgets, rising healthcare costs, small risk pool, irregular contributions, and overutilization of services. At the delivery level, accessibility of facilities, facility environment, and health personnel influenced enrollment, service utilization and dropout rates. Conclusion There are a multitude of interrelated factors at the individual, interpersonal, community and systems levels that drive the implementation, uptake and sustainability of CBHI schemes. We discuss the implications of the findings at the policy and research level. Trial registration The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID =  CRD42015019812 ).

Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.

Background The National Health Insurance Scheme (NHIS) in Nigeria aims to improve access to healthcare and reduce out-of-pocket payments, yet persistent dissatisfaction with NHIS-provided services threatens enrollee retention and scheme sustainability. This study assessed satisfaction and willingness to retain NHIS membership among enrollees at a tertiary hospital in Ebonyi State and explored implications for community-based health insurance policy and service-delivery reform. Methods We conducted a convergent parallel mixed-methods study comprising a survey of 376 NHIS enrollees attending outpatient clinics at Alex Ekwueme University Teaching Hospital, Abakaliki, and in-depth phenomenological interviews with with 20 enrollees (10 males, 10 females, aged 24–68years, NHIS enrolment 5–11years). Convenience sampling was used. Satisfaction with NHIS services was measured using a 4-point Likert scale, and associations with willingness to retain membership were examined using chi-square tests, Cramér’s V and predictive Lambda at p<0.05. Qualitative data were analysed thematically with MAXQDA to contextualise service-delivery experiences and retention decisions. Results Respondents ( n =376; age 21–65years) were predominantly middle-aged, female, married, tertiary educated and employed as civil servants, with most reporting access to healthcare. Overall, 61.8% of enrollees were satisfied with NHIS services, and satisfaction strongly predicted willingness to retain membership (Χ 2 =121.14, df=1; Cramér’s V=0.57; p <0.0001); 74.4% of those willing to retain membership reported being satisfied. Predictive Lambda indicated that knowing satisfaction status substantially improved prediction of retention (λ[A from B]=0.83 vs. λ[B from A]=0.79). Qualitative findings highlighted long waiting times, drug stock-outs, bureaucratic inefficiencies and poor provider–patient interactions as major sources of dissatisfaction, particularly among rural and lower-income enrollees. Conclusions This single-centre mixed-methods study shows that while nearly two-thirds of NHIS enrollees were satisfied with the quality and affordability of scheme-provided services, persistent service-delivery gaps and administrative bottlenecks undermine retention intentions. Policy adjustments that prioritise improving service delivery, addressing administrative inefficiencies and strengthening provider–patient relationships are likely to enhance satisfaction and retention within the NHIS. These findings also offer practical insights for the design and scaling of community-based health insurance and related service-delivery reforms in similar mixed urban–rural settings, and for advancing equity-focused progress towards universal health coverage and related Sustainable Development Goals.

Background Despite the long-standing implementation of Ethiopia’s community-based health insurance (CBHI) program and numerous original studies, no national pooled data exist regarding disparities in modern health service utilization (MHSU) between insured and uninsured households within CBHI. Therefore, this meta-analysis aimed to ascertain the extent of MHSU disparities between CBHI member and non-member households in Ethiopia. Methods We searched Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar on March 22, 2024. The Joanna Briggs Institute (JBI) critical appraisal tools were used to assess the risk of bias, and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines were followed to structure the review. Data analysis was conducted using Stata 17. Heterogeneity was examined through sensitivity and subgroup analyses. Publication bias was initially assessed using the Luis Furuya-Kanamori (LFK) index, which indicated major asymmetry; therefore, a random-effects model was applied, which resolved the asymmetry and was used to estimate pooled effects at a significant level of p less than 0.05 with 95% CIs. We also performed Egger’s test, which was non-significant ( p  = 0.440), indicating the absence of small-study effects and suggesting that publication bias did not influence the results of the meta-analysis. Results The meta-analysis revealed that the prevalence of MHSU among CBHI member households was 63%, compared with 44% among non-members, reflecting a 19% gap in MHSU between insured and uninsured families. The comparison generally showed that the insured households were 3.26 times more likely to use modern health services than their uninsured counterparts (OR = 3.26, 95% CI = 2.41–4.11). Conclusion The analysis revealed that households participating in the CBHI scheme accessed modern health services more often than those not enrolled. This difference suggests that people without CBHI may face barriers to accessing care. This difference suggests that people without CBHI may face barriers to accessing care. The finding highlights an opportunity for policymakers to expand CBHI coverage to include more households and to improve the benefit packages for current members, with the goal of achieving universal access to healthcare. Prospero identifier https://www.crd.york.ac.uk/PROSPERO/view/CRD42022355972