A mixed methods study of community-based health insurance enrollment trends and underlying challenges in two districts of northeast Ethiopia: A proxy for its sustainability

Abstract

Background The term "community-based health insurance" refers to a broad range of nonprofit, prepaid health financing models designed to meet the health financing needs of disadvantaged populations, particularly those in the rural and informal sectors. Due to their voluntary nature, such initiatives suffer from persistently low coverage in low- and middle-income countries. In Ethiopia, the schemes’ membership growth has not been well investigated so far. This study sought to examine the scheme’s enrollment trend over a five-year period, and to explore the various challenges that underpin membership growth from the perspectives of various key stakeholders. Methods The study employed a mixed methods case study in two purposively selected districts of northeast Ethiopia: Tehulederie and Kallu. By reviewing the databases of health insurance schemes, quantitative data were collected retrospectively from 2017 to 2021 to examine enrollment trends. Trends for each performance indicator were analyzed descriptively for the period under study. Face-to-face interviews were conducted with nine community members and 19 key informants. Study participants were purposely selected using the maximum variation technique. Interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was employed with both deductive and inductive coding approaches. Results Over the course of the study period, enrollment in the scheme at both districts exhibited non-linear trends with both positive and negative growth rates being identified. Overall, the scheme in Tehulederie has a relatively higher population coverage and better membership retention, which could be due to the strong foundation laid by a rigorous public awareness campaign and technical support during the pilot phase. The challenges contributing to the observed level of performance have been summarized under four main themes that include quality of health care, claims reimbursement for insurance holders, governance practices, and community awareness and acceptability. Conclusions The scheme experienced negative growth ratios in both districts, indicating that it is not functionally viable. It will fail to meet its mission unless relevant stakeholders at all levels of government demonstrate political will and commitment to its implementation, as well as advocate for the community. Interventions should target on the highlighted challenges in order to boost membership growth and ensure the scheme’s viability.

Perception among NHIS–HMO Enrolees of the Attitudes of Medical Personnel during Outpatient Care in Lagos Hospitals

“…The authors of [6][7][8][9] suggested that variables related to medical personnel attitudes towards NHIS enrolees are related to socioeconomic and healthcare plans. The IDI finding was also consistent with enrolees' low-level satisfaction with medical personnel attitudes in Ghana [21] and Kallu, Ethiopia [22].…”

Closed-globe injury due to metallic foreign body in an elderly worker: A case report

“…It is noteworthy that even though the JKN covered the medical bills, the patient chose not to attend further outpatient follow-up, possibly due to concerns about taking work leave. Similar cases of indirect financial problems by insurance-enrolled patients were noted in Ethiopia [ 13 ]. This case underscores the importance of addressing multifaceted challenges within the healthcare system to ensure timely and equitable access to essential medical care.…”