The interaction of healthcare service quality and community-based health insurance in Ethiopia.

Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interacti...

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Autores principales:	Bekele Belayihun Tefera, Mengistu Asnake Kibret, Yordanos B Molla, Girma Kassie, Aynalem Hailemichael, Tarekegn Abate, Hailu Zelelew, Binyam Fekadu Desta, Elizabeth Futrell, Zewditu Kebede, Gebeyehu Abelti, Subrata Routh, Bamikale Feyisetan, Abdulmumin Saad
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6ffdfafbcbac487aa9307b066e29f021
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spelling	oai:doaj.org-article:6ffdfafbcbac487aa9307b066e29f0212021-12-02T20:17:45ZThe interaction of healthcare service quality and community-based health insurance in Ethiopia.1932-620310.1371/journal.pone.0256132https://doaj.org/article/6ffdfafbcbac487aa9307b066e29f0212021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256132https://doaj.org/toc/1932-6203Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.Bekele Belayihun TeferaMengistu Asnake KibretYordanos B MollaGirma KassieAynalem HailemichaelTarekegn AbateHailu ZelelewBinyam Fekadu DestaElizabeth FutrellZewditu KebedeGebeyehu AbeltiSubrata RouthBamikale FeyisetanAbdulmumin SaadPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0256132 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bekele Belayihun Tefera Mengistu Asnake Kibret Yordanos B Molla Girma Kassie Aynalem Hailemichael Tarekegn Abate Hailu Zelelew Binyam Fekadu Desta Elizabeth Futrell Zewditu Kebede Gebeyehu Abelti Subrata Routh Bamikale Feyisetan Abdulmumin Saad The interaction of healthcare service quality and community-based health insurance in Ethiopia.
description	Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.
format	article
author	Bekele Belayihun Tefera Mengistu Asnake Kibret Yordanos B Molla Girma Kassie Aynalem Hailemichael Tarekegn Abate Hailu Zelelew Binyam Fekadu Desta Elizabeth Futrell Zewditu Kebede Gebeyehu Abelti Subrata Routh Bamikale Feyisetan Abdulmumin Saad
author_facet	Bekele Belayihun Tefera Mengistu Asnake Kibret Yordanos B Molla Girma Kassie Aynalem Hailemichael Tarekegn Abate Hailu Zelelew Binyam Fekadu Desta Elizabeth Futrell Zewditu Kebede Gebeyehu Abelti Subrata Routh Bamikale Feyisetan Abdulmumin Saad
author_sort	Bekele Belayihun Tefera
title	The interaction of healthcare service quality and community-based health insurance in Ethiopia.
title_short	The interaction of healthcare service quality and community-based health insurance in Ethiopia.
title_full	The interaction of healthcare service quality and community-based health insurance in Ethiopia.
title_fullStr	The interaction of healthcare service quality and community-based health insurance in Ethiopia.
title_full_unstemmed	The interaction of healthcare service quality and community-based health insurance in Ethiopia.
title_sort	interaction of healthcare service quality and community-based health insurance in ethiopia.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6ffdfafbcbac487aa9307b066e29f021
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The interaction of healthcare service quality and community-based health insurance in Ethiopia.

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