&lt;p&gt;Investigation of Moral Hazard Deportments in Community-Based Health Insurance in Guto Gida District, Western Ethiopia: A Qualitative Study&lt;/p&gt;

Ayana, Isubalew Daba

doi:10.2147/ceor.s269561

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…There are 3 government health centers, 23 governmental health post and six private health facilities in the district. According to the District CBHI scheme office there were an estimated 30,357 households in the District among this, 14670(48.3%) households were enrolled in CBHI [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Factors associated with enrollment for community-based health insurance scheme in Western Ethiopia: Case-control study

Fite

Roba²,

Merga³

et al. 2021

PLoS ONE

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Introduction Modern health services utilization in developing countries has continued low. Financial shortage to access health-care services might be averted by stirring from out-of-pocket payment for health care at the time of use. The government of Ethiopia; depend greatly on foreign aid (50%) and out-of-pocket payments (34%) to fund health services for its population. This study was aimed to identify factors associated with households’ enrollment to CBHI scheme membership. Methods Case-control study design was conducted from May 18–July 27, 2019 among 332 participants (166 enrolled and 166 non-enrolled to CBHI scheme). Simple random sampling technique was used to select the study participants. Bi-variable and multivariable logistic regression model were fitted to identify factors associated with enrollment to community based health insurance. Adjusted odds ratio (AOR) with 95% CI was used to report association and significance was declared at P<0.05. Result A total of 332 (100% response rate) were involved in the study. Educational status (College and above, AOR = 3.90, 95%CI; 1.19, 12.75), good awareness about CBHI scheme (AOR = 21.595, 95% CI; 7.561, 61.681), affordability of premium payment (AOR = 3.403, 95% CI; 5.638–4.152), wealth index {(Poor, AOR = 2.59, 95%CI; 1.08, 6.20), (Middle, AOR = 4.13, 95%CI; 1.11, 15.32)} perceived health status (AOR = 5.536; 95% CI; 1.403–21.845), perceived quality of care (AOR: 21.014 95%CI; 4.178, 105.686) and treatment choice (AOR = 2.94, 95%CI; 1.47, 5.87) were factors significantly associated with enrollment to CBHI. Conclusion Enrolment to CBHI schemes is influenced by educational level, awareness level, affordability of premium, wealth index, perceived health status, perceived quality of care and treatment choice. Implementation strategies aimed at raising community awareness, setting affordable premium, and providing quality healthcare would help in increasing enrollment of all eligible community groups to the CBHI scheme.

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Section: Methodsmentioning

confidence: 99%

Factors associated with enrollment for community-based health insurance scheme in Western Ethiopia: Case-control study

Fite

Roba²,

Merga³

et al. 2021

PLoS ONE

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“…•Demands extraordinary drugs; tend to collect more drugs; giving their card to non-insured, and frequent health facility visits were the clients' side moral hazard practices [ 68 ]…”

Section: Resultsmentioning

confidence: 99%

“…•Overestimating the cost of services to CBHI members, occasional charges of undelivered insurance services, and health providers insulting service users were also the moral hazard of service providers [ 68 ]…”

Section: Resultsmentioning

confidence: 99%

“…Demands extraordinary drugs; tend to collect more drugs, and give their card to non-insured patients from the client side while overestimating the cost of services. The charge of undelivered insurance services from service providers' perspective were frequently occurred moral hazards to deliver healthcare services by CBHI [ 68 ]. Low awareness and benefit packages, poor perception of quality of health services, and lack of trust of the management [ 69 – 72 ] were the challenges to enrol CBHI membership.…”

Section: Resultsmentioning

confidence: 99%

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Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis

Debie

Khatri

Assefa

2022

BMC Health Serv Res

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Background High burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia. Methods We searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing. Results A total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia’s health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments. Conclusion Ethiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.

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“…Second, in the division of the outcome variable in QCA, although it is more appropriate to calibrate continuous variables by using fs/QCA, it is difficult to find appropriate anchor points for variable calibration because of the large difference in the loss involved in cases, therefore we classified the outcome variables according to the reliable classification basis found in China's relevant laws. Finally, due to the limitation of case data, the variables used in this study may not be able to capture all the possible causal complexity of medical insurance moral hazard, and demographic characteristics such as age, gender, patient's disease category, and differences in the departments that provide inpatient services may also lead to deviations in the results ( 25 , 75 , 76 ). Hence, one important suggestion is that conduct research on medical insurance moral hazards of key populations.…”

Section: Limitationsmentioning

confidence: 99%

How do moral hazard behaviors lead to the waste of medical insurance funds? An empirical study from China

Qin

Liu

et al. 2022

Front. Public Health

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ObjectiveThe huge loss of health insurance funds has been a topic of concern around the world. This study aims to explore the network of moral hazard activities and the attribution mechanisms that lead to the loss of medical insurance funds.MethodsData were derived from 314 typical cases of medical insurance moral hazards reported on Chinese government official websites. Social network analysis (SNA) was utilized to visualize the network structure of the moral hazard activities, and crisp-set qualitative comparative analysis (cs/QCA) was conducted to identify conditional configurations leading to funding loss in cases.ResultsIn the moral hazard activity network of medical insurance funds, more than 50% of immoral behaviors mainly occur in medical service institutions. Designated private hospitals (degree centrality = 33, closeness centrality = 0.851) and primary medical institutions (degree centrality = 30, closeness centrality = 0.857) are the main offenders that lead to the core problem of medical insurance fraud (degree centrality = 50, eigenvector centrality = 1). Designated public hospitals (degree centrality = 27, closeness centrality = 0.865) are main contributor to another important problem that illegal medical charges (degree centrality = 26, closeness centrality = 0.593). Non-medical insurance items swap medical insurance items (degree centrality = 28), forged medical records (degree centrality = 25), false hospitalization (degree centrality = 24), and overtreatment (degree centrality = 23) are important immoral nodes. According to the results of cs/QCA, low-economic pressure, low informatization, insufficient policy intervention, and organization such as public medical institutions, were the high-risk conditional configuration of opportunism; and high-economic pressure, insufficient policy intervention, and organizations, such as public medical institutions and high violation rates, were the high-risk conditional configuration of risky adventurism (solution coverage = 31.03%, solution consistency = 90%).ConclusionThere are various types of moral hazard activities in medical insurance, which constitute a complex network of behaviors. Most moral hazard activities happen in medical institutions. Opportunism lack of regulatory technology and risky adventurism with economic pressure are two types causing high loss of funds, and the cases of high loss mainly occur before the government implemented intervention. The government should strengthen the regulatory intervention and improve the level of informatization for monitoring the moral hazard of medical insurance funds, especially in areas with low economic development and high incident rates, and focus on monitoring the behaviors of major medical services providers.

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<p>Investigation of Moral Hazard Deportments in Community-Based Health Insurance in Guto Gida District, Western Ethiopia: A Qualitative Study</p>

Cited by 5 publications

References 17 publications

Factors associated with enrollment for community-based health insurance scheme in Western Ethiopia: Case-control study

Factors associated with enrollment for community-based health insurance scheme in Western Ethiopia: Case-control study

Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis

How do moral hazard behaviors lead to the waste of medical insurance funds? An empirical study from China

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