https://orcid.org/0000-0002-8060-3922
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ABSTRACT
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.
Responsible Editor Jennifer Stewart Williams
Responsible Editor Jennifer Stewart Williams
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2189764
Author contributions
Ewunetie Mekashaw Bayked and Husien Nurahmed Toleha conceived and designed the review, supervised and performed the review, extracted, analyzed, and interpreted the data, wrote the paper, and contributed to the writing and reviewing of the manuscript. Seble Zewdu Kebede conceived and designed the review, extracted and performed the review, analyzed and interpreted the data, and wrote and reviewed the manuscript. Mesfin Haile Kahissay and Birhanu Demeke Workneh conceived and designed the review, supervised the review, analyzed and interpreted the data, and reviewed the manuscript. All authors have reviewed and approved the final version of the manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Paper context
Ethiopia has been implementing community-based health insurance since 2011 with the aim of achieving universal health coverage. However, the nationwide impact of the scheme has still not been evaluated comprehensively. Therefore, in order to address this, we undertook a systematic review and meta-analysis. It revealed that less than 50% of the population had access to universal health care. The finding indicates that Ethiopia should move to a broader national scheme that covers the entire population.
Correction Statement
This article has been corrected with minor changes. These changes do not impact the academic content of the article.