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Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments

Received: 13 July 2019    Accepted: 7 August 2019    Published: 26 December 2019
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Abstract

Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.

Published in International Journal of Health Economics and Policy (Volume 4, Issue 4)
DOI 10.11648/j.hep.20190404.16
Page(s) 158-167
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Community Based Health Insurance, Behavioral Biases, Discrete Choice Experiment, Willingness to Pay, Addis Ababa

References
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[3] Amaya-Amaya M, Ryan M, GerardK. Using Discrete Choice Experiments to Value Health and Health Care. The Economics of Non-Market Goods and Resources. 2008; 11: 13-46.
[4] Anagaw D, Sparrow Z, Yilma GA, Bedi AS. Enrollment in Ethiopia’s Community-Based Health Insurance Scheme. World Development. 2015; 74: 58-76.
[5] Anoo N. Health Insurance in Developing Countries: Willingness to Pay for Health Insurance in Thailand using Discrete Choice Experiment Methods. Curtin University: Centre for International Health; 2011.
[6] Asmamaw, A. (2018). CBHI in Ethiopia: Enrollment, Membership renewal and Effect on health care utilization. Seoul: Seoul National University; 2018.
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[18] MelakuH, Shimeles O, Berhane M. Willingness to join community-based health insurance among rural households of Debub Bench District, Bench Maji Zone, Southwest Ethiopia. BMC Public Health. 2014; 14: 591.
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Cite This Article
  • APA Style

    Abel Eshetu, Abrham Seyoum. (2019). Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. International Journal of Health Economics and Policy, 4(4), 158-167. https://doi.org/10.11648/j.hep.20190404.16

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    ACS Style

    Abel Eshetu; Abrham Seyoum. Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. Int. J. Health Econ. Policy 2019, 4(4), 158-167. doi: 10.11648/j.hep.20190404.16

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    AMA Style

    Abel Eshetu, Abrham Seyoum. Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. Int J Health Econ Policy. 2019;4(4):158-167. doi: 10.11648/j.hep.20190404.16

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  • @article{10.11648/j.hep.20190404.16,
      author = {Abel Eshetu and Abrham Seyoum},
      title = {Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments},
      journal = {International Journal of Health Economics and Policy},
      volume = {4},
      number = {4},
      pages = {158-167},
      doi = {10.11648/j.hep.20190404.16},
      url = {https://doi.org/10.11648/j.hep.20190404.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20190404.16},
      abstract = {Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments
    AU  - Abel Eshetu
    AU  - Abrham Seyoum
    Y1  - 2019/12/26
    PY  - 2019
    N1  - https://doi.org/10.11648/j.hep.20190404.16
    DO  - 10.11648/j.hep.20190404.16
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    JF  - International Journal of Health Economics and Policy
    JO  - International Journal of Health Economics and Policy
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    PB  - Science Publishing Group
    SN  - 2578-9309
    UR  - https://doi.org/10.11648/j.hep.20190404.16
    AB  - Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.
    VL  - 4
    IS  - 4
    ER  - 

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Author Information
  • Zemen Bank Risk Management Department, Addis Ababa, Ethiopia

  • Center for Rural Development, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia

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