Free health care provision and its financial implications in Gondar town, northwest Ethiopia

Ashagrie, Gizachew; Abebe, Yekoye

doi:10.4314/ejhd.v18i2.9949

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…This differs to the findings of the research done in Gondar from secondary data where 46,178 (17.7 %) of the patients were free health service beneficiaries. The reason for difference could be due to the difference in methodology, time, socio-economic status [ 19 ]. On the other hand, the result of facility exit survey conducted in Jimma, southwest reported about 58 % of the respondents were free health care beneficiaries [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, the result of facility exit survey conducted in Jimma, southwest reported about 58 % of the respondents were free health care beneficiaries [ 20 ]. The gap among these three studies may be due to the absence of clearly stated criteria for recruiting and providing waive certificate as it is suggest by the two previous studies [ 19 , 20 ] and failure to serve the disadvantaged and vulnerable groups. There might be missing of the vulnerable and including those who do not deserve.…”

Section: Resultsmentioning

confidence: 99%

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The revenue generated from clinical chemistry and hematology laboratory services as determined using activity-based costing (ABC) model

Adane

Abiy

Desta

2015

Cost Eff Resour Alloc

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Background The rapid and continuous growth of health care cost aggravates the frequently low priority and less attention given in financing laboratory services. The poorest countries have the highest out-of-pocket spending as a percentage of income. Higher charges might provide a greater potential for revenue. If fees raise quality sufficiently, it can enhance usage. Therefore, estimating the revenue generated from laboratory services could help in capacity building and improved quality service provision.Methods Panel study design was used to determine revenue generated from clinical chemistry and hematology services at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. Activity-Based Costing (ABC) model was used to determine the true cost of tests performed from October 2011 to December 2011 in the hospital. The principle of Activity-based Costing is that activities consume resources and activities consumed by services which incur the costs and hence service takes the cost of resources. All resources with costs are aggregated with the established casual relationships. The process maps designed was restructured in consultation with the senior staffs working and/or supervising the laboratory and pretested checklists were used for observation. Moreover, office documents, receipts and service bills were used while collecting data. The amount of revenue collected from services was compared with the cost of each subsequent test and the profitability or return on investment (ROI) of services was calculated. Data were collected, entered, cleaned, and analyzed using Microsoft Excel 2007 software program and Statistical Software Package for Social Sciences version 19 (SPSS). Paired sample t test was used to compare the price and cost of each test. P-value less than 0.05 were considered as statistically significant.ResultA total of 25,654 specimens were analyzed during 3 months of regular working hours. The total numbers of clinical chemistry and hematology tests performed during the study period were 45,959 (66.1 %) and 23,570 (33.9 %), respectively. Only 274, 386 (25.3 %) Ethiopian Birr (ETB) was recovered from the total cost of 1,086,008.09 ETB incurred on clinical chemistry and hematology laboratory tests. The result showed that, about 133,821 (12.32 %) ETB was revenue not collected from out-of-pocket payments that was paid for the services as a result of under pricing. The result showed that 18 out of 20 laboratory tests were under priced. The cost burden related to free Anti Retro-viral Therapy (ART) services was 285,979.82 (26.3 %) ETB.ConclusionThe cost per test estimated was significantly different to the existing price. About 90 % of the tests were under priced. This information could warn the hospital to reconsider resetting prices of these tests profitability ration less than 1. The revenue collected could help to build capacity, upscale quality, and sustainable service delivery.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The revenue generated from clinical chemistry and hematology laboratory services as determined using activity-based costing (ABC) model

Adane

Abiy

Desta

2015

Cost Eff Resour Alloc

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“…Health care policy in Ethiopia has traditionally maintained strong social protection and equity dimensions. To this end, poor households have been exempted from paying for certain basic health services (Ashagrie & Abebe, 2017;Kloos, 1998;Purvis et al, 2011). This fee waiver system, which has been running for over a decade, is still operational in woredas in which the CBHI has not yet been rolled out.…”

Section: Health Fee Waiver Systemmentioning

confidence: 99%

Evidence from the Productive Safety Net Programme in Ethiopia: Complementarities between social protection and health policies

Hirvonen

Bossuyt

Pigois³

2021

Development Policy Review

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Motivation: Social protection policies typically involve multiple sectors, ranging from food security to health care. Despite this, limited research is directed toward understanding how different social protection programmes complement each other. Purpose: We explore complementarities between three major national social protection programmes in rural Ethiopia: the Productive Safety Net Programme (PSNP), the Community Based Health Insurance (CBHI) scheme and the Health Fee Waiver (HFW) system. Approach and methods: We use secondary data from districts in which the PSNP operates to study the coverage of the CBHI and the HFW schemes. We then quantify the prevalence of health shocks reported by poor households and calculate the annual out-of-pocket (OOP) health care expenses incurred by poor households in these districts. Findings: We find limited overlap between the PSNP and the CBHI or HFW schemes. In districts in which the CBHI operates, about 22% of the PSNP households are enrolled into CBHI. For 10% of all PSNP households, the CBHI insurance premium was waived due to their poverty status. In non-CBHI districts, 3.5% of PSNP households report having benefitted from HFW. Moreover, many households report serious health shocks that resulted in loss of consumption or assets. The estimated OOP health expenditures are high, even among those households enrolled into CBHI or benefitting from HFW. Policy implications: Taken together, these findings suggest that there is scope to improve the linkages between these three major social protection programmes in Ethiopia to protect the poorest and most vulnerable households. K E Y W O R D Shealth care policy, health insurance, safety nets, social protection 1. To improve access to health services by making it more affordable. 2. To improve the quality of the health services. 3. To improve the financial viability of the health sector. 4. To engage and strengthen community participation in the management of health services. 5. To strengthen the capacity of the national health sector.The decision to enrol into the scheme is left to kebeles (sub-districts), which, together with woreda officials, manage the scheme (EHIA, 2015). Once the kebele has joined the scheme, each household 2 These selection criteria were set to ensure that the CBHI scheme would be implemented well during the pilot phase. This in turn increases the likelihood that the scheme has a positive impact on its beneficiaries. It is important to note that these same criteria do not necessarily apply once the scheme is scaled up.

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“…However, the system is susceptible to about 35.8% partiality and 44.5% inappropriate treatment, stigma, and discrimination against the fee waiver users by health professionals. 20 , 21 About 36% and 14.7% are susceptible to possible under-coverage and leakage, respectively. Attaining the goals of health service equity in Ethiopia has not progressed well.…”

Section: Introductionmentioning

confidence: 99%

“…Besides, inhabitants of the rural areas who might not even be aware of such a system’s existence are not benefiting, which adversely affects equity. 20 …”

Section: Introductionmentioning

confidence: 99%

Health Service Utilization Among Out-of-Pocket Payers and Fee-Wavier Users in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia: A Comparative Cross-Sectional Study

Gessesse¹,

Yitayal²,

Kebede³

et al. 2021

RMHP

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Background Health service utilization among out-of-pocket payers and fee-wavier users and factors associated with it in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia. Methods A comparative community-based cross-sectional study was conducted in Northern Ethiopia. Households with at least one person who experienced illness during the last six months were included in the study. Data were collected using a structured and interviewer-administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the HSU. Results In this study, 652 individuals (489 OOP payers and 163 fee waiver users) participated with overall response rate of 98%. The overall HSU among the participants was 44.3% (41.9 for OOP users and 51.5% for fee waiver users). The study revealed that educational status (AOR = 0.35; 95% CI: 0.21, 0.59), family size (AOR = 0.60; 95% CI: 0.37, 0.97) and income level (AOR = 2.09; 95% CI: 1.12, 3.90, and AOR = 4.12; 95% CI: 2.41, 7.53) were factors significantly associated with the HSU among OOP payers. The study also revealed that educational status (AOR = 0.65; 95% CI: 0.21, 0.59), family size (AOR = 0.4; 95% CI: 0.37, 0.97), income level (AOR = 1.12; 95% CI: 1.21, 4.87), and payment mechanism (AOR = 2.21; 95% CI = 1.34, 4.67 were significantly associated with the HSU among all study participants. Conclusion This study shows that the level of the HSU is low. Educational status, family size, economic status, and payment mechanism were significantly associated with the HSU. Therefore, improving the community’s educational level, promoting family planning, devising income-generating strategies, and strengthening the fee waiver mechanism may enhance the HSU.

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Free health care provision and its financial implications in Gondar town, northwest Ethiopia

Cited by 6 publications

References 7 publications

The revenue generated from clinical chemistry and hematology laboratory services as determined using activity-based costing (ABC) model

The revenue generated from clinical chemistry and hematology laboratory services as determined using activity-based costing (ABC) model

Evidence from the Productive Safety Net Programme in Ethiopia: Complementarities between social protection and health policies

Health Service Utilization Among Out-of-Pocket Payers and Fee-Wavier Users in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia: A Comparative Cross-Sectional Study

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